Is MASH on Your Radar? Screening and Management Strategies

Is MASH on Your Radar? Screening and Management Strategies is organized by Med-IQ.

Released: 6/16/2025
Expires: 6/15/2026

Overview:
Primary care clinicians and endocrinologists play a critical role in identifying and managing metabolic dysfunction-associated steatohepatitis (MASH) before it progresses. Results from a Med-IQ survey, however, revealed that approximately half of respondents screen only 50% or fewer of their patients with obesity or type 2 diabetes. Patients with these conditions or other risk factors, such as metabolic syndrome, dyslipidemia, or elevated liver enzymes, should be screened using noninvasive tools like FIB-4, transient elastography (FibroScan), ELF, or VCTE.

Although lifestyle modification remains the cornerstone of treatment, pharmacologic options such as GLP-1 receptor agonists, pioglitazone, and resmetirom may be appropriate based on individual risk profiles. Most patients can be effectively managed in primary care or endocrinology settings, with hepatology referral recommended for patients with a high risk of advanced fibrosis.

Learning Objectives:
Upon completion, participants should be able to:

• Apply screening pathways for primary and secondary fibrosis risk stratification in patients with risk factors for MASH
• Select MASH management strategies for patients based on their fibrosis risk stratification and other comorbidities

Statement of Need
The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) is rising in parallel with other metabolic conditions such as obesity and type 2 diabetes (T2D). Early detection and staging of MASLD, followed by appropriate management, can help prevent progression to MASH and more severe outcomes like fibrosis, cirrhosis, and hepatocellular carcinoma. More than 95% of individuals with an increased risk of MASH are managed in primary care settings. Although more primary care physicians (PCPs) and endocrinologists are recognizing the growing incidence of MASLD/MASH among their patients, many still lack clarity on how to address it effectively. Indeed, results from a national MASH needs assessment survey found that fewer than 50% of endocrinologist respondents (n = 175) and PCP respondents (n = 401) knew that MASLD is common in people with T2D, and only 28% of endocrinologist respondents and 32% of PCP respondents knew that individuals with severe obesity were more likely to have MASLD. Additionally, awareness of diagnostic and management guidelines remains low, with one survey indicating that only 53% of PCPs (N = 101) were familiar with current recommendations. This knowledge gap contributes to the underutilization of noninvasive testing for screening, fibrosis risk stratification, and timely referral to specialists. Although most PCPs and endocrinologists report advising patients on lifestyle modifications, such as exercise and diet as recommended by recent guidelines, more frequently prescribed medications include metformin, whereas guideline-recommended therapies like glucagon-like peptide-1 receptor agonists are less commonly used. This underscores the critical need for continued education on guideline recommendations, particularly regarding fibrosis risk stratification and evidence-based treatment approaches.