The newly proposed clinical care pathway for metabolic dysfunction-associated steatotic liver disease (MASLD) represents an important step toward standardizing the evaluation and management of one of the most prevalent chronic liver diseases globally. MASLD, closely linked to obesity, type 2 diabetes, and other cardiometabolic risk factors, is frequently managed in primary care and endocrinology settings, necessitating practical, scalable approaches to care.
This pathway introduces a structured, stepwise framework focused on early identification and risk stratification of patients at risk for clinically significant fibrosis, the key determinant of liver-related outcomes. Initial evaluation involves identifying at-risk populations—particularly individuals with type 2 diabetes, obesity, or multiple metabolic risk factors—followed by routine laboratory testing and clinical assessment. Non-invasive fibrosis scoring systems, such as simple serum-based indices, are recommended as first-line tools to stratify patients into low-, intermediate-, and high-risk categories.
Patients categorized as low risk can typically be managed in primary care with emphasis on lifestyle interventions, including weight loss, dietary modification, and physical activity, alongside optimization of metabolic comorbidities. In contrast, individuals with indeterminate or high-risk scores are recommended for further evaluation using advanced non-invasive modalities such as liver stiffness measurement or proprietary biomarker panels. Those with confirmed or suspected advanced fibrosis should be referred to hepatology specialists for further assessment, including consideration of liver biopsy and surveillance for complications such as cirrhosis or hepatocellular carcinoma.
Importantly, the pathway underscores the central role of multidisciplinary care involving primary care physicians, endocrinologists, and hepatologists to address the complex interplay of metabolic and hepatic disease. Given that cardiovascular disease remains the leading cause of mortality in MASLD, comprehensive risk factor management is emphasized alongside liver-specific care. By integrating non-invasive diagnostics, clear referral thresholds, and coordinated care models, this clinical pathway aims to enhance early detection, improve patient stratification, and optimize outcomes. Its implementation is expected to reduce unnecessary specialist referrals while ensuring timely intervention for high-risk patients, ultimately addressing the growing global burden of MASLD.
Link: https://www.gastrojournal.org/article/S0016-5085(26)00198-8/abstract
