Metabolic dysfunction-associated steatotic liver disease (MASLD) or Metabolic-associated fatty liver disease (MAFLD), has become the most common chronic liver disease, and its prevalence will likely continue to rise.

Dr Ross Apostolov, a gastroenterologist and hepatologist, has provided a summary of the The EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD, which were published late 2024.

The EASL-EASD-EASO Clinical Practice Guidelines on the Management of MASLD

Background
  • MASLD is the most common chronic liver disease globally, linked to type 2 diabetes (T2D), obesity, and cardiometabolic risks.
  • It encompasses MASL (isolated steatosis), MASH (steatohepatitis), fibrosis, and cirrhosis.
  • MASLD replaces the old terminology NAFLD and is part of steatotic liver disease (SLD), alongside alcohol-related and other etiologies.
  • Australia has not yet formally adopted the use of “MASLD” as terminology and our local guidelines refer to it as metabolic associated fatty liver disease, or “MAFLD”, which can be considered interchangeable with MASLD.
Disease Characteristics
  • MASLD increases the risks of cardiovascular disease, chronic kidney disease, liver failure, and hepatocellular carcinoma (HCC).
  • Nearly all NAFLD-related findings are transferable to MASLD; however, MetALD (a subtype of fatty liver where patients also have moderate alcohol intake) is distinct.
Alcohol & MASLD
Statements
  • Alcohol consumption and metabolic risk factors independently and synergistically influence chronic liver disease progression.
  • Emerging evidence disputes the protective effect of moderate alcohol consumption, especially in those with cardiometabolic risks.
Recommendations
  • Document alcohol intake (amount, pattern, history) in all SLD cases.
  • Discourage alcohol use in SLD, particularly in moderate-to-high alcohol consumers. Aim <7 standard drinks/week.
  • Absolute cessation is mandatory in advanced fibrosis or cirrhosis.

Diagnosis

  • Early fibrosis diagnosis and management can prevent progression to cirrhosis.
  • Case Finding –

Target individuals with :

  • T2D
  • Abdominal obesity + ≥1 metabolic risk factor
  • Abnormal liver enzymes or imaging

Management
Lifestyle
  • Weight loss, regular exercise, and alcohol avoidance
Pharmacological
  • For T2D/obesity: Incretin-based therapies (e.g., semaglutide)
  • For MASH with fibrosis: Refer to a hepatologist for clinical trials as there are no approved treatments yet in Australia.
  • Treat cholesterol if this is an existing co-factor
Advanced Disease
  • Nutrition counseling, portal hypertension and HCC surveillance, and liver transplant in decompensated cirrhosis
Care Pathways

A step wise approach is recommended –

  • Step 1: Non-patented blood tests (e.g., FIB-4)
  • Step 2: Imaging techniques for fibrosis confirmation in high-risk cases

If uncertain, refer to an expert gastroenterologist or hepatologist.

Fig. 1 Flow chart for steatotic liver disease and its sub-categories