Author: Holly Giles
Speakers: Dr Gautum Mehta, Dr Jenneffer Tibaes
Panellists: Professor Sumantra Ray, Dr Rajna Golubic, Ramya Rajaram & Sarah Armes
Acknowledgements: We would also like to acknowledge Randox Health for their funding and support of both the workshop and the ongoing systematic review.
Reviewer: Sarah Armes
Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most common chronic liver conditions, often associated with obesity or type 2 diabetes [1]. Previously termed non-alcoholic fatty liver disease (NAFLD), the nomenclature change aims to reduce stigma and enhance healthcare understanding and support for this condition [2].
Alongside this shift in terminology, growing recognition of the role of lifestyle factors has prompted a transition from reactive to preventative approaches in MASLD management.
In November 2024, NNEdPro presented a summary of current understanding of MASLD and lifestyle factors with talks by key researchers in this area.
Lifestyle management for MASLD
Alcohol consumption
There is an increased prevalence of MASLD in patients with obesity and type 2 diabetes, meaning that lifestyle factors can have a preventative effect on MASLD development. It was highlighted that alcohol use has a synergistic impact on cardiometabolic risk factors, showing the importance of lifestyle choices on disease progression.
The negative impacts of binge drinking, not currently considered in UK drinking guidelines, were emphasised on the risk of liver injury [3]. Positively, it was shown that 1-month of abstinence from alcohol (in the form of dry January) was associated with an improved risk profile for MASLD [3], meaning lifestyle factors not only drive disease progression but can also have protective effects.
Weight loss
Weight loss was emphasised as an important avenue for overweight patients, with waist circumference acting as an independent marker of MASLD risk. Meta-analysis data was presented, showing the benefits of calorie restriction and adherence to a Mediterranean diet on liver stiffness.
The beneficial effects of physical activity were enhanced, showing the importance of both diet and exercise for MASLD patients.
Dietary choices
Using meta-analysis of dietary components, red meat and soft drink consumption were both shown to contribute to MASLD risk. Contrastingly, nut consumption was shown to have a favourable effect. This presentation by Dr Mehta highlighted the importance of lifestyle management, both with regards to physical activity and dietary choices, of MASLD prevention and progression.
Pharmacy in MASLD Management
Polypharmacy, defined as the regular use of 5 or more medications, presents a challenge to clinicians in the treatment and management of MASLD. One challenge is the differentiation between clinical symptoms of the disease and side effects as a result of polypharmacy and drug interactions.
Polypharmacy significantly impacts the quality of life of patients due to the presence of side effects, as well as compounding the socioeconomic cost of this condition [4]. Many of the issues of polypharmacy can be avoided or reduced through lifestyle factors, as these reduce the need for medication and can facilitate medication de-escalation. This highlights the need for a holistic, patient-centred approach to treatment, with sufficient support for patients to adopt the recommended lifestyle changes.
The challenges associated with polypharmacy for MASLD management have been highlighted in the systematic review, which is anticipated to be published in 2025.
Panel Q&A on MASLD treatment and prevention
In the panel discussion, the panellists addressed several key barriers that prevent patients from adopting the recommended lifestyle changes. Acknowledging the impact of food poverty, financial constraints, and limited access to resources, the panellists noted that these factors significantly hinder many patients' ability to make necessary lifestyle adjustments. Furthermore, the challenge of achieving long-term behavioural change was discussed, emphasising the critical role of clinical support and clear, consistent messaging in helping patients achieve sustainable improvements.
The panel highlighted the need for multidisciplinary teams to provide comprehensive support for MASLD patients. These teams should not only focus on the clinical management of the condition but also assist patients in making the lifestyle changes necessary to reduce disease progression. It was suggested that patient care teams should include dietitians, behavioural psychologists, and health promotion practitioners, all of whom could contribute to facilitating long-term behavioural change and enhancing patient outcomes.
Looking ahead, the panellists discussed the potential for future advancements in MASLD treatment, including the expansion of population screening programs. These programs could enable earlier identification of MASLD patients, allowing for timely lifestyle interventions as a primary preventive measure.
This discussion underscored the critical importance of lifestyle choices in the occurrence and progression of MASLD. It is hoped that greater awareness of this relationship, along with the integration of multidisciplinary support to foster patient-led behavioural changes, will lead to improved care and management of MASLD in the future.
References
Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review. J Obes Metab Syndr. 2023;32(3):197-213.
Rinella ME, Sookoian S. From NAFLD to MASLD: updated naming and diagnosis criteria for fatty liver disease. J Lipid Res. 2024;65(1):100485.
Mehta G, Macdonald S, Cronberg A, Rosselli M, Khera-Butler T, Sumpter C, et al. Short-term abstinence from alcohol and changes in cardiovascular risk factors, liver function tests and cancer-related growth factors: a prospective observational study. BMJ Open. 2018;8(5):e020673.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65.
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