Question 1

What is MASLD (formerly NAFLD)?

Accepted Answer

MASLD (metabolic dysfunction-associated steatotic liver disease) — formerly called non-alcoholic fatty liver disease (NAFLD) — is excess fat accumulation in the liver (hepatic steatosis ≥5%) in people with cardiometabolic risk factors (obesity, diabetes, hypertension, dyslipidaemia) and without excessive alcohol consumption or other hepatic causes. It is a spectrum: simple steatosis (generally benign) → MASH (inflammatory, scarring) → cirrhosis → liver failure or liver cancer.

Question 2

Why was NAFLD renamed MASLD?

Accepted Answer

The 2023 renaming from NAFLD to MASLD (and NASH to MASH) addressed several problems with the original terminology: "non-alcoholic" was defined by what the disease is NOT — stigmatising and confusing; "fatty liver" was perceived as stigmatising overweight patients; and the new names explicitly recognise the metabolic drivers (insulin resistance, cardiometabolic dysfunction). The new nomenclature also introduced MetALD (metabolic dysfunction + alcohol-associated liver disease) for those with both conditions.

Question 3

How does MASLD progress?

Accepted Answer

The MASLD spectrum: (1) Simple steatosis (most patients) — fat accumulation without significant inflammation; stable in approximately 80%. (2) MASH (approximately 20-25% of steatosis) — fat + lobular inflammation + hepatocyte ballooning ± fibrosis; risk of progression. (3) Fibrosis (stages F0-F4) — progressive scarring. (4) Cirrhosis (F4) — develops in approximately 20-25% of MASH over 10-15 years. (5) Hepatocellular carcinoma (HCC) — can occur even in non-cirrhotic MASH (a key feature distinguishing MASLD-HCC from viral hepatitis-HCC).

Question 4

What is resmetirom (the first approved MASH drug)?

Accepted Answer

Resmetirom (Rezdiffra, Madrigal Pharmaceuticals) — FDA-approved in March 2024 — is the first and currently only approved pharmacological treatment specifically for MASH. It is a selective thyroid hormone receptor beta (THR-β) agonist that reduces hepatic lipogenesis and increases lipid oxidation, reducing hepatic fat, inflammation and fibrosis — without systemic thyroid effects (THR-β is preferentially expressed in the liver). MAESTRO-NASH Phase 3 trial showed histological resolution of MASH in 25-30% vs approximately 10% placebo. Approved for non-cirrhotic MASH with moderate-advanced fibrosis (F2-F3).

Question 5

How is MASLD diagnosed?

Accepted Answer

MASLD diagnosis requires: demonstrating hepatic steatosis (liver ultrasound — most accessible; MRI-PDFF quantitative; liver biopsy — gold standard for MASH diagnosis and staging); excluding other causes (significant alcohol use, viral hepatitis, autoimmune liver disease, drug-induced); and confirming metabolic risk factors. Fibrosis staging: FIB-4 score (first-line non-invasive test — recommended by WHO/EASL); liver stiffness measurement (FibroScan — validated non-invasive); or liver biopsy (required for MASH diagnosis confirmation in clinical trials).

Question 6

How is MASLD treated?

Accepted Answer

Lifestyle modification is the cornerstone — weight loss ≥10% reverses MASH in approximately 90% and improves fibrosis: reduced calorie diet; Mediterranean dietary pattern (highest evidence); structured exercise (reduces liver fat independent of weight loss). Specific pharmacotherapy: resmetirom for MASH F2-F3 fibrosis (FDA 2024). Other metabolic drugs with hepatic benefits: GLP-1 receptor agonists (semaglutide, liraglutide — reduce liver fat, inflammation; trials ongoing for fibrosis endpoints); SGLT-2 inhibitors (modest liver benefit); pioglitazone (improves MASH histology). Bariatric surgery in severe obesity substantially reverses MASLD/MASH.

Question 7

What is the link between MASLD and other metabolic diseases?

Accepted Answer

MASLD is both a consequence and driver of metabolic syndrome. It is essentially the hepatic manifestation of insulin resistance. Bidirectional associations: obesity and type 2 diabetes dramatically increase MASLD risk; MASLD independently increases type 2 diabetes risk (hepatic insulin resistance); MASLD patients have higher cardiovascular mortality (cardiovascular disease, not liver disease, is the primary cause of death in most MASLD patients). Treatment of metabolic risk factors (diabetes, obesity, dyslipidaemia) simultaneously treats MASLD.

Question 8

How does GMJ News cover MASLD?

Accepted Answer

GMJ News covers WHO liver disease data, the NAFLD→MASLD renaming, resmetirom FDA approval, semaglutide liver trials, FIB-4 screening, and the obesity-MASLD-HCC connection. MASLD is an increasingly recognised liver disease in Georgia — directly relevant to PHIG's NCD programme and the Georgian Medical Journal's hepatology and metabolism coverage.

GMJ News

Non-Alcoholic Fatty Liver Disease (MASLD)

Key messages

Key statistics

Glossary of key terms

Latest GMJ coverage

Frequently asked questions 12 Q&A — structured for Google featured snippets and AI discovery

Knowledge hub: guidelines, conventions and reports

Organizations working in migration and health

Related health topics

Company