Providing holistic care for patients with metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis: Key aspects of clinical assessment and how to develop individualised care plans for surveillance and interventions.

This review article discusses metabolic dysfunction-associated steatotic liver disease (MASLD) as a highly prevalent condition (affecting over 30% of adults) characterized by hepatic steatosis in the presence of metabolic risk factors such as obesity, type 2 diabetes, dyslipidaemia, and hypertension. It outlines the disease spectrum from simple steatosis through metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma.

A major emphasis is that most patients with non-cirrhotic MASLD die from extrahepatic causes, especially cardiovascular disease and non-hepatic cancers. This underlines the need for a holistic approach that addresses both liver-related and systemic risks rather than focusing solely on hepatic endpoints.

The authors highlight the heterogeneity of MASLD driven by sex-specific factors, genetic predisposition, varying cardiometabolic risk profiles, lifestyle patterns, and socio-economic determinants. This variability supports a shift toward individualized, risk-adapted management rather than a one-size-fits-all strategy.

While lifestyle modification remains the foundation of therapy, the article notes a rapidly evolving therapeutic landscape. Resmetirom and semaglutide are now approved for non-cirrhotic MASH with moderate-to-advanced fibrosis, and metabolic/bariatric surgery is presented as a highly effective option in appropriate patients. These interventions are framed within the broader need to control cardiometabolic comorbidities and malignancy risk.

The review advocates a stepwise, integrated care model incorporating early case-finding, non-invasive risk stratification, and tailored combinations of lifestyle, pharmacologic, and surgical interventions. It underscores the value of multiprofessional care teams—including behavioural therapists, dieticians, and physiotherapists—to enhance adherence and outcomes, particularly in high-risk populations.

Overall, the article synthesizes current knowledge on MASLD heterogeneity, assessment, and treatment, and proposes principles for coordinated, individualized care that accounts for both hepatic and extrahepatic complications.

• Prevalence and definition: MASLD affects over 30% of adults and is defined by hepatic steatosis with metabolic risk factors.
• Disease spectrum: Ranges from simple steatosis to MASH, fibrosis, cirrhosis, and hepatocellular carcinoma.
• Extrahepatic risk: Most non-cirrhotic MASLD patients die from cardiovascular disease and non-hepatic cancers.
• Heterogeneity: Driven by sex, genetics, cardiometabolic risk, lifestyle, and socio-economic factors.
• Treatment foundation: Lifestyle modification remains central to management.
• Therapeutic advances: Resmetirom, semaglutide, and metabolic/bariatric surgery for selected patients with non-cirrhotic MASH and fibrosis.
• Integrated care model: Emphasizes early case-finding, non-invasive risk stratification, and tailored therapy.
• Multiprofessional teams: Involvement of behavioural therapists, dieticians, and physiotherapists to improve adherence and outcomes.
• Overall goal: Coordinated, individualized care addressing both hepatic and extrahepatic complications.