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AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease
Open accessAbstract
PREAMBLE The study of NAFLD has intensified significantly, with more than 1400 publications since 2018, when the last American Association for the Study of Liver Diseases (AASLD) Guidance document was published.1 This new AASLD Guidance document reflects many advances in the field pertinent to any practitioner caring for patients with NAFLD and emphasizes advances in noninvasive risk stratification and therapeutics. A separate guideline focused on the management of patients with NAFLD in the context of diabetes has been written jointly by the American Association of Clinical Endocrinology and AASLD.2 Given the significant growth in pediatric NAFLD, it will not be covered here to allow for a more robust discussion of the diagnosis and management of pediatric NAFLD in the upcoming AASLD Pediatric NAFLD Guidance. A “Guidance” differs from a “Guideline” in that it is not bound by the Grading of Recommendations, Assessment Development and Evaluation system. Thus, actionable statements rather than formal recommendations are provided herein. The highest available level of evidence was used to develop these statements, and, where high-level evidence was not available, expert opinion was used to develop guidance statements to inform clinical practice. Key points highlight important concepts relevant to understanding the disease and its management. The most profound advances in NAFLD relevant to clinical practice are in biomarkers and therapeutics. Biomarkers and noninvasive tests (NITs) can be used clinically to either exclude advanced diseases or identify those with a high probability of cirrhosis.3,4 NIT “cut points” vary with the populations studied, underlying disease severity, and clinical setting. Those proposed in this guidance are meant to aid decision-making in the clinic and are not meant to be interpreted in isolation. Identifying patients with “at-risk” NASH (biopsy-proven NASH with stage 2 or higher fibrosis) is a more recent area of interest. Although the definitive diagnosis and staging of NASH remain linked to histology, noninvasive tools can now be used to assess the likelihood of significant fibrosis, predict risk of disease progression and decompensation, make management decisions, and, to some degree, assess response to treatment. There is an ongoing debate over the nomenclature of fatty liver disease, which had not been finalized at the time this guidance was published. At the culmination of a rigorous consensus process, it is intended that any formal change in nomenclature will advance the field without a negative impact on disease awareness, clinical trial endpoints, or the drug development/approval process. Furthermore, it should allow for the emergence of newly recognized disease subtypes to address the impact of disease heterogeneity, including the role of alcohol, on disease progression and response to therapy. Input from patients has been central to all stages of the consensus process to ensure the minimization of nomenclature-related stigma. DEFINITIONS NAFLD is an overarching term that includes all disease grades and stages and refers to a population in which ≥5% of hepatocytes display macrovesicular steatosis in the absence of a readily identified alternative cause of steatosis (eg, medications, starvation, monogenic disorders) in individuals who drink little or no alcohol (defined as < 20 g/d for women and <30 g/d for men). The spectrum of disease includes NAFL, characterized by macrovesicular hepatic steatosis that may be accompanied by mild inflammation, and NASH, which is additionally characterized by the presence of inflammation and cellular injury (ballooning), with or without fibrosis, and finally cirrhosis, which is characterized by bands of fibrous septa leading to the formation of cirrhotic nodules, in which the earlier features of NASH may no longer be fully appreciated on a liver biopsy. UPDATE ON EPIDEMIOLOGY AND NATURAL HISTORY The prevalence of NAFLD and NASH is rising worldwide in parallel with increases in the prevalence of obesity and metabolic comorbid disease (insulin resistance, dyslipidemia, central obesity, and hypertension).5,6 The prevalence of NAFLD in adults is estimated to be 25%–30% in the general population7–9 and varies with the clinical setting, race/ethnicity, and geographic region studied but often remains undiagnosed.10–14 The associated economic burden attributable to NASH is substantial.15–17 The prevalence of NASH in the general population is challenging to determine with certainty; however, NASH was identified in 14% of asymptomatic patients undergoing colon cancer screening.14 This study also highlights that since the publication of a prior prospective prevalence study,18 the prevalence of clinically significant fibrosis (stage 2 or higher fibrosis) has increased >2-fold. This is supported by the projected rise in NAFLD prevalence by 2030, when patients with advanced hepatic fibrosis, defined as bridging fibrosis (F3) or compensated will the proj
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“Based on this, it seems reasonable to conclude that should patients continue to complete guideline-based amounts of aerobic exercise over a longer duration, fibrosis improvement may follow [35, 36].”
From Aerobic Exercise Training Leads to MASH Resolution as Defined by the MASH Resolution Index (2026) · cites this paper as [35]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Moreover, interventions in diet and physical activity are considered to be the cornerstone of management in the whole MASLD spectrum [7, 10].”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [7]
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In the citing paper
“Although there is no consensus on the optimal diet for treating MASLD, the EASL-EASD-EASO guidelines recently recommended the MD as the preferred option [7, 10].”
From Effects of Mediterranean diet, exercise, and their combination on body composition and liver outcomes in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials (2025) · cites this paper as [7]
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“Current guidelines recommend weight loss through dietary modifications, increased physical activity, or both combined in MASLD patients [7, 11, 12].”
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“Various scienti fi c societies have recommended clinical care pathways with an emphasis on the use of non-invasive tests (NITs) and the liaison between primary care/non-hepatology and hepatology settings.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [126]
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“GLP-1RA-based drugs have been proven beneficial to some extent in dedicated trials and should be considered in patients with obesity and/or T2D and metabolic dysfunction-associated steatohepatitis (MASH)90.”
From Incretin-based therapies for the treatment of obesity-related diseases (2024) · cites this paper as [90]
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“46 A weight loss of as little as 5% already ameliorates of whole-body and tissue-specific insulin sensitivity, decreases visceral adipose mass by ~ 10% and liver lipid content by ~ 40%.”
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“…elastography; TN, true negative; TP, true positive the American Association for Clinical Endocrinology (AACE) and America Diabetes Association [12 − 15] These strategies recommend fi brosis-4 index (FIB-4) as a simple and inexpensive fi rst-line assessment in the primary care setting [16,17].”
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“…the Study of Liver Diseases (AAS-LD), European Association for the Study of the Liver (EASL), and American Gastroenterology Association (AGA) all advise MASLD screening in patients with type 2 diabetes mellitus (T2DM) or prediabetes, obesity, and at least one cardiometabolic risk factor (20–22).”
InfluentialHFpEF and MASLD: converging mechanisms and clinical implications
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“Despite these promising associations, statins and fibrates are not recommended specifically for treating hepatic disease activity in MASLD owing to limited direct evidence of benefit for liver histology parameters 10,247 .”
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Population screening for cirrhosis
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“TABLE 3 Recommendations for liver fibrosis detection in primary care and the population from international scientific organizations AASLD [46] AACE [47] EASL [48] ALEH [49] APASL [50] EASL, EASD, and EASO [51] EASL [52] Year”
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“Although it is known to be less accurate than non-invasive methods such as transient elastography or magnetic resonance elastography, FIB-4 is a non-invasive scoring system recommended by most guidelines as the first step to differentiate advanced liver fibrosis [37].”
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“Patients with cirrhosis, and also probably those with advanced fibrosis, will be recommended to undergo a 6-monthly surveillance program as is done for cirrhosis of any aetiology [5].”
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“Using this approach to screen for those most likely to have fibrosis and thus be at risk for cirrhosis and HCC may be cost-effective, as screening all patients is not recommended [79, 80].”
Behari, J., Wang, R., Luu, H. N., McKenzie, D., Molinari, M., & Yuan, J. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000471 · Cited by 25
“…in most clinical settings, and targeted screening for MASLD with liver fibrosis has recently been recommended in certain high-risk subgroups, [22] lack of systematic screening in the general population makes it difficult to completely elucidate the relationship between the severity of…”
BackgroundArai, T., Atsukawa, M., Tsubota, A., Oikawa, T., Tada, T., Matsuura, K., Ishikawa, T., Abe, H., Kato, K., Morishita, A., et al. (2024) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15898 · Cited by 29
Posttransplant diabetes mellitus: recent developments in pharmacological management of hyperglycemia
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Screening for social determinants of health among populations at risk for MASLD: a scoping review
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Monitoring disease progression in metabolic dysfunction‐associated steatotic liver disease
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“16,32”
BackgroundSelf-citationDiehl, D. L., Sangwan, V., Khurana, S., Khara, H. S., Zhang, J., & Confer, B. D. (2024) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2024.10.064 · Cited by 23
Moving diagnosis of liver fibrosis into the community
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Disease classification, diagnostic challenges, and evolving clinical trial design in MASLD
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“Adopting a holistic approach to diagnostics in MASLD is crucial due to the interconnected nature with metabolic syndrome, obesity, hypertension, dyslipidemia, and insulin resistance (25).”
InfluentialNoureddin, M., Alkhouri, N., Lawitz, E., Kowdley, K. V., Loomba, R., Lee, L. K., Jones, C. T., Schlegel, A., Marmon, T., Anderson, K., et al. (2025) · Nature Medicine · doi:10.1038/s41591-025-03722-7 · Cited by 23
“The clinical characteristics of patients in DUET were largely consistent with previous phase 2 studies in patients with MASH 18,44 and reflected an at-risk, comorbid MASH population 3 .”
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“Exercise training is beneficial for hepatic and cardiometabolic function in patients with MAFLD/NAFLD [122], with improvements in vascular stiffness and endothelial dysfunction that lower the cardiovascular risk [123].”
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“5,6 9 Genetic factors including multiple established common variants contribute to the risk of MASLD and disease severity 10,11 Family studies have revealed that first-degree relatives of probands with MASLD and advanced fibrosis have an elevated risk of advanced fibrosis.”
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“…Study of Liver Diseases (AASLD) guidelines for NAFLD, which can be applied to patients with MASLD due to high overlap between both populations [13, 14], recommend the use of noninvasive tests (NITs), specifically the fibrosis-4 (FIB-4) index, for the initial screening of advanced fibrosis in…”
BackgroundMethodResultInfluentialSqualene Epoxidase: Its Regulations and Links with Cancers
Zhang, L., Cao, Z., Hong, Y., He, H. H., Chen, L., Yu, Z., & Gao, Y. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25073874 · Cited by 22
Review article: Hepatic steatosis and its associations with acute and chronic liver diseases
Koenig, A. B., Tan, A., Abdelaal, H., Monge, F., Younossi, Z. M., & Goodman, Z. D. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18059 · Cited by 25
“64 Percutaneous liver biopsy is associated with risk of a major bleed that occurs in less than 2% of recipients, infection, sepsis and organ perforation.”
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“MASLD is a spectrum of liver conditions that may range from simple hepatic steatosis to metabolic dysfunction-associated steatohepatitis (MASH) when there is histologic evidence of inflammation and hepatocellular injury (hepatocyte ballooning with or without fibrosis) (Figure 2) [2].”
BackgroundMethodInfluentialStatin prescriptions and progression of advanced fibrosis risk in primary care patients with MASLD
Schreiner, A. D., Zhang, J., Petz, C. A., Moran, W. P., Koch, D. G., Marsden, J. E., Bays, C., Mauldin, P. D., & Gebregziabher, M. (2024) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2024-001404 · Cited by 23
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Bile acid signaling in MASLD: From pathogenesis to therapeutic applications
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Targeting MASLD and MASH in the US Hispanic/Latino Population: A Review
Cumpian, N. A., Gutierrez, J. A., Wu, W., & Saab, S. (2025) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.4769 · Cited by 22
Wong, Y. J., Urias, E., Song, M. W., Goyal, T., Tay, W. X., Han, N. X., Loo, J. H., Qiu, T. Y., Wijarnpreecha, K., Chan, Y. H., et al. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000244 · Cited by 23
“[21] Further, there are very limited data on how to interpret discordant results, such as high/intermediate FIB-4 with low LSM, or low FIB-4 with high LSM. Current guidelines recommend the use of liver biopsy in the setting of discordant results between FIB-4 and LSM. [5,22] In practice, repeat LSM may be considered i…”
BackgroundInfluentialAllen, A. M., Pose, E., Reddy, K. R., Russo, M. W., & Kamath, P. S. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.11.007 · Cited by 22
Liver stiffness as a cornerstone in heart disease risk assessment
Boeckmans, J., Sandrin, L., Knackstedt, C., & Schattenberg, J. M. (2023) · Liver International · doi:10.1111/liv.15801 · Cited by 24
“9,13 The presence of MASLD and advanced fibrosis increase the risk of CVD, while CVD is a primary cause of death in patients with MASLD.”
BackgroundPirola, C. J., Salatino, A., Gianotti, T. F., Castaño, G. O., Garaycoechea, M. E., & Sookoian, S. C. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.104996 · Cited by 22
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“Genetic testing and gene-based risk stratification are not currently recommended in a clinical setting [5,27].”
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Role of MASLD in CVD: A review of emerging treatment options
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“These include increased physical activity with aerobic exercise along with exercise with resistance, weight loss, and stricter adherence to a Mediterranean diet [5,10,11].”
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“However, its use is hampered by the limitations of risk, cost, and resource utilization, according to the American Association for the Study of Liver Diseases guidelines [2].”
Sharma, A. R., Leiva, E. G., Kalavalapalli, S., Lomonaco, R., MARANGI, S. A., SAENZ, E. V., Gonzalez, M. A., Rocha, A. O., CUERVO-PARDO, N., Rosenberg, J. T., et al. (2024) · Obesity · doi:10.1002/oby.24130 · Cited by 21
“IR has been a well-established risk factor for the development of hepatic steatosis and fibrosis [ 2, 3, 26].”
InfluentialSelf-citationDas, T. S., Meng, X., Abdallah, M., Bilal, M., Sarwar, R., & Shaukat, A. (2024) · Diagnostics · doi:10.3390/diagnostics14222478 · Cited by 21
Elevated GGT to HDL ratio as a marker for the risk of NAFLD and liver fibrosis
Xuan, Y., He, F., Liu, Q. F., Dai, D., Wu, D., Shi, Y., & Yao, Q. Z. (2025) · Scientific Reports · doi:10.1038/s41598-024-84649-w · Cited by 25
Jiang, J., Xie, Z., Wang, Q., Wang, B., Huang, R., Xu, W., Shang, C., & Chen, Y. (2025) · BMC Public Health · doi:10.1186/s12889-024-21192-3 · Cited by 22
Li, H., Hou, Y., Xin, W., Ding, L., Yang, Y., Zhang, Y., Wu, W., Wang, Z., & Ding, W. (2025) · Pharmacological Research · doi:10.1016/j.phrs.2025.107647 · Cited by 22
Drapkina, O. M., Евстифеева, С. Е., Shalnova, S. A., Kutsenko, V. A., Balanova, Y. А., Имаева, А. Э., Владимировна, К. А., Kotova, M. B., Maksimov, S. A., Аркадьевна, М. Г., et al. (2025) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2025-4316 · Cited by 21
Advancing precision medicine in metabolic dysfunction-associated steatotic liver disease
Priego-Parra, B. A., Gallego‐Durán, R., Román-Calleja, B. M., Velasco, J. A. V.-R., Romero‐Gómez, M., & Gracia‐Sancho, J. (2025) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2025.03.006 · Cited by 22
Balkhed, W., Bergram, M., Iredahl, F., Holmberg, M., Edin, C., Carlhäll, C., Ebbers, T., Henriksson, P., Simonsson, C., Rådholm, K., et al. (2025) · Journal of Internal Medicine · doi:10.1111/joim.20103 · Cited by 25
“…for the Study of Liver Diseases proposed that all patients with T2DM be screened for advanced fibrosis using the fibrosis-4 (FIB-4) score, and if it is elevated, proceed with vibration-controlled transient elastography (VCTE), magnetic resonance elastography, or the enhanced liver fibrosis test [15].”
Non-Alcoholic Fatty Liver Disease as an Emerging Risk Factor for Heart Failure
Inciardi, R. M., Mantovani, A., & Targher, G. (2023) · Current Heart Failure Reports · doi:10.1007/s11897-023-00613-1 · Cited by 25
“NAFL is defined histologically by the presence of macrovesicular steatosis in ≥ 5% of hepatocytes without evidence of hepatocyte injury (ballooning) in persons with no or little alcohol consumption [12, 18 • ].”
BackgroundMethodInfluentialA novel HIF2A mutation causes dyslipidemia and promotes hepatic lipid accumulation
Gao, F., Yao, Q., Zhu, J., Chen, W., Feng, X., Feng, B., Wu, J., Pacák, K., Rosenblum, J. S., Yu, J., et al. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.106851 · Cited by 22
Ouzan, D., Pénaranda, G., Jlaiel, M., Joly, H., & Corneille, J. (2024) · Scientific Reports · doi:10.1038/s41598-024-62549-3 · Cited by 21
“FIB-4 is the most validated among the simple tests for fibrosis 16,17,20 .”
BackgroundMethodInfluentialFishman, J., Qian, C., Kim, Y., Rochon, H., Szabo, S. M., Sun, R., & Charlton, M. (2024) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2024.24069 · Cited by 21
Role of gut microbiota and immune cells in metabolic-associated fatty liver disease: clinical impact
Alisi, A., McCaughan, G. W., & Grønbæk, H. (2024) · Hepatology International · doi:10.1007/s12072-024-10674-6 · Cited by 21
“Recommendations for non-invasive tests (NIT) in clinical practice have recently been updated [83–85].”
Amorim, R., Soares, P., Chavarria, D., Benfeito, S., Cagide, F., Teixeira, J., Oliveira, P. J., & Borges, F. (2024) · European Journal of Medicinal Chemistry · doi:10.1016/j.ejmech.2024.116723 · Cited by 21
Prevalence of Low FIB‐4 in MASLD‐Related Hepatocellular Carcinoma: A Multicentre Study
Tan, D. J. H., Tamaki, N., Kim, B. K., Wijarnpreecha, K., Aboona, M. B., Faulkner, C., Kench, C., Salimi, S., Sabih, A., Lim, W. H., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18346 · Cited by 23
Self-citationPaik, A., Henry, L. L., de Avila, L., Alqahtani, S. A., Nader, F., Paik, J. M., & Younossi, Z. M. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.08.053 · Cited by 21
Miller, K. C., Geyer, B., Alexopoulos, A., Moylan, C. A., & Pagidipati, N. J. (2024) · Digestive Diseases and Sciences · doi:10.1007/s10620-024-08722-0 · Cited by 23
“While not currently FDA-approved for treatment of MASLD, recent studies have also shown that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce hepatic steatosis and fibrosis, though no mortality benefit has been observed and larger studies are still ongoing [46, 55, 56].”
Younossi, Z. M., Mangla, K. K., Chandramouli, A. S., & Lazarus, J. V. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000488 · Cited by 20
“…as age (y) × aspartate aminotransferase (U/L)/(platelets [10 9 /L] × alanine aminotransferase [U/L] 1/2 ) and categorized as low ( 1.30), intermediate (1.30 – 2.67), or 25 – 28] Baseline comorbidities were defined as conditions that had been diagnosed in the 12 months before the index date.”
BackgroundInfluentialBae, J., Han, E., Lee, H. W., Park, C., Chung, C. H., Lee, D. H., Cho, E. H., Rhee, E., Yu, J. H., Park, J. H., et al. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2024.0541 · Cited by 23
“A greater-than-moderate amount of alcohol consumption (≥210 g/week or ≥30 g/day for men and ≥140 g/week or ≥20 g/day for women) is also an exclusion criterion [13,14].”
van Kleef, L. A., Pustjens, J., Savas, M., Ayada, I., Li, P., Pan, Q., van Rossum, E. F. C., Janssen, H. L. A., & Brouwer, W. P. (2024) · Liver International · doi:10.1111/liv.16169 · Cited by 20
Noninvasive Quantitative CT for Diffuse Liver Diseases: Steatosis, Iron Overload, and Fibrosis
Pickhardt, P. J., & Lubner, M. G. (2024) · Radiographics · doi:10.1148/rg.240176 · Cited by 21
Huang, Y., Li, J., Liu, C., Song, D., Zhu, C., Ren, Y., Lv, J., Jiang, L., Shan, R., Wang, H., et al. (2025) · MedComm · doi:10.1002/mco2.70123 · Cited by 20
“The interpretation of CAP value requires knowledge of etiology [9], and there are no clear cutoff values of CAP to grade steatosis [10, 11].”
Resmetirom: the first approved therapy for treating metabolic dysfunction associated steatohepatitis
Bhushan, S. R., Sohal, A., Noureddin, M., & Kowdley, K. V. (2025) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2025.2478917 · Cited by 20
Pecani, M., Andreozzi, P., Cangemi, R., Corica, B., Miglionico, M., Romiti, G. F., Stefanini, L., Raparelli, V., & Basili, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14082750 · Cited by 23
“…with MASH cirrhosis are at higher risk for liver-related complications, and they should undergo regular surveillance for HCC and esophageal varices [122, Additionally, e ff ective management of comorbidities (e.g., obesity, IR, IFG, T2D, dyslipidemia, HTN, gut dysbiosis, etc.) is essential for…”
InfluentialKanda, T., Sasaki, R., Abé, H., Kimura, N., Yoshida, T., Hayashi, K., Sakamaki, A., Yokoo, T., Kamimura, H., Tsuchiya, A., et al. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26115164 · Cited by 20
“MASH is associated with an increased risk of hepatic complications, including cirrhosis, hepatic decompensation, and HCC, as well as extra-hepatic complications, including cardiovascular disease (CVD) and chronic kidney disease [12–14].”
Zargar, A. H., Bhansali, A. K., Majumder, A., Maheshwari, A., Bhattacharyya, A., Dasgupta, A., Saboo, B., Sethi, B. K., Sanyal, D., Seshadri, K., et al. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16496 · Cited by 25
“62,69,71 Prognostic scoring systems such as fibrosis 4 (FIB-4) score, NAFLD Fibrosis Score (NFS) and AST to Platelet Ratio Index (APRI) remain valuable tools for predicting liver-related outcomes and mortality (Table 5).”
Cusi, K. J., Budd, J., Johnson, E. L., & Shubrook, J. H. (2024) · Diabetes Spectrum · doi:10.2337/dsi23-0014 · Cited by 20
“75% of people in the United States have over-weight or obesity and 85% have one cardiometabolic risk factor even without steatosis (29), the new de fi nition over-all appears to correlate well with NAFLD.”
BackgroundInfluentialCombination Therapy of Endoscopic Gastric Remodeling with GLP-1RA for the Treatment of MASLD
Jirapinyo, P., Jaroenlapnopparat, A., Zucker, S. D., & Thompson, C. C. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07178-5 · Cited by 20
“Specifically, the NITs of interest were alanine aminotransferase (ALT), NAFLD fibrosis score (NFS), fibrosis-4 (FIB-4) score, and LSM on VCTE [14, 18].”
Bauer, D. J. M., Nixdorf, L., Dominik, N., Schwarz, M., Hofer, B., Hartl, L., Semmler, G., Jachs, M., Simbrunner, B., Jedamzik, J., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.18019 · Cited by 21
“13 Although these techniques are discussed as promising candidates in some of the guidelines, they are not explicitly endorsed by the current EASL, 17 AASLD, 32 or BAVENO VII Guidelines, 29 due to a lack of confirmatory studies particularly in the setting of obesity.”
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“Precisely for this reason, both the American [96] and European [97] guidelines recommend lifestyle modifications with the implementation of physical exercise and, above all, changes in eating habits as the truly useful approach for the management of patients with MAFLD.”
From NAFLD to MASLD: what does it mean?
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“NAFLD is characterized by fat accumulation exceeding 5% within the liver, i.e. steatosis, and necessitates the exclusion of secondary causes of fatty liver including alcoholic liver disease (ALD) [3] (Figure 1).”
Kang, Y. W., Baek, Y. H., & Moon, S. Y. (2024) · Diagnostics · doi:10.3390/diagnostics14222517 · Cited by 19
Pharmacological management of pediatric metabolic dysfunction‐associated steatotic liver disease
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“Despite the existing guidelines for screening, diagnosing and managing MASLD [10, 12, 15], evidence suggests that they have not been widely adopted by healthcare providers (HCPs) in Europe [14, 16–18].”
Brennan, P., Kopka, C. J., Agirre‐Garrido, L., Hansen, C. D., Alkhouri, N., Schattenberg, J. M., Wajcman, D. I., Isaacs, S. D., Michel, M. S., & Lazarus, J. V. (2025) · npj gut and liver. · doi:10.1038/s44355-024-00017-5 · Cited by 22
“…counseling in accordance with the 2018/2023 AASLD Practice Guidance recommendations, which advocated for weight loss through a hypocaloric diet and nutritional modi fi cation (daily reduction of 500 to 1000 kilocalories), either alone or in combination with moderate-intensity exercise 42,43 .”
Screening for advanced steatotic liver disease
Johansen, S., Åberg, F. O., Tsochatzis, E. A., & Krag, A. A. (2025) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(25)00097-4 · Cited by 19
The Expanding Scope of GLP-1 Receptor Agonists: Six Uses Beyond Diabetes
Sheth, K., Kim, S., Porterfield, L. R., Virani, S. S., Wadhwani, S., & Vaughan, E. M. (2025) · Current Atherosclerosis Reports · doi:10.1007/s11883-025-01319-6 · Cited by 20
“Current management guidance from the American Association for the Study of Liver Diseases emphasizes lifestyle modification and optimization of comorbidities (e.g., diabetes, obesity) while acknowledging only a handful of drug therapies with proven benefit, including GLP-1RAs [ 54].”
The endocrine role of hepatokines: implications for human health and disease
Iglesias, P. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1663353 · Cited by 23
Global performance of non-invasive tests in MASLD: Insights from the G-MASLD study
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The Basics of Metabolic Dysfunction–Associated Steatotic Liver Disease for Cardiologists
Khan, M. S., Javaid, S. S., Dinani, A. M., Wegermann, K., Pandey, A., Bhatt, A. S., Muthiah, M. D., Spall, H. G. C. V., Zannad, F. M., Butler, J., et al. (2025) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2025.08.100 · Cited by 22
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“Current EASL-EASO-EASD and AASLD guidelines recommend the use of PPAR-gamma agonist Pioglitazone yet concerning side effects, such as weight gain and fluid retention, have been obstacles in its widespread use[127,209,210].”
Screening for NAFLD—Current Knowledge and Challenges
Forlano, R., Sigon, G., Mullish, B. H., Yee, M. S., & Manousou, P. (2023) · Metabolites · doi:10.3390/metabo13040536 · Cited by 22
FIB-4 and APRI for cirrhosis detection in a privately insured national cohort
Parikh, N. D., Mehta, M., & Tapper, E. B. (2023) · JHEP Reports · doi:10.1016/j.jhepr.2023.100925 · Cited by 19
“13 Our data suggests that when applying these indices to the general population, using age and comorbidities to pre-select a higher-risk population may be more effective.”
Metadata
- Authors
- Rinella, M. E., Neuschwander-Tetri, B. A., Siddiqui, M. S., Abdelmalek, M. F., Caldwell, S., Barb, D., Kleiner, D. E., & Loomba, R.
- Affiliations
- University of Chicago (US)
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
- Virginia Commonwealth University (US)
- Mayo Clinic (US)
- University of Virginia (US)
- University of Florida Health (US)
- National Institutes of Health (US)
- University of California San Diego (US)
- Corresponding author
- Rinella, Mary E.
- ORCID
- Venue
- Hepatology
- Published
- 2023-03-17
- Volume
- 77
- Issue
- 5
- Pages
- 1797-1835
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC10735173
- OpenAlex
- W4318923555
- Cited by
- 2,667
- References
- 502
- Citations by year
- 2026: 849 · 2025: 845 · 2024: 691 · 2023: 281
- FWCI
- 532.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- American Association for the Study of Liver Diseases
- NGM Biopharmaceuticals
- Novo Nordisk
- National Institutes of Health
- Allergan
- National Cancer Institute (ZICBC010685)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, non-invasive risk stratification, non-invasive tests, fibrosis staging, liver cirrhosis
- MeSH terms
- Humans, Liver, Liver Cirrhosis, Disease Progression, Non-alcoholic Fatty Liver Disease
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