Gastroenterology and hepatology
MASLD and MASH (formerly NAFLD and NASH)
The 2023 steatotic liver disease nomenclature, who to test, FIB-4 then elastography, why fibrosis and the heart decide prognosis, weight-loss targets, and where semaglutide, resmetirom, pioglitazone, vitamin E and bariatric surgery fit.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The commonest chronic liver disease in Australia, affecting about a third of adults (MJA 2026 review). It is rising with obesity and type 2 diabetes.
- Most patients die of cardiovascular disease, not liver disease. Liver outcomes are driven by fibrosis stage.
- Risk-stratify with FIB-4, then elastography (or ELF). Normal ALT doesn't exclude advanced fibrosis.
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Sources
- EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024;81:492-542European Association for the Study of the Liver, EASD and EASO, 2024
- Brouwer WP et al. Steatotic liver disease trajectory: a holistic EASL guidance on the multidisciplinary approach to screening and patient management. JHEP Rep 2026;8:101798European Association for the Study of the Liver, 2026
- Rinella ME et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023;77:1797-835, with the October 2024 resmetirom updateAmerican Association for the Study of Liver Diseases, 2023, updated 2024
- Rinella ME et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol 2023;79:1542-56AASLD, EASL and ALEH, 2023
- Cusi K et al. Metabolic dysfunction-associated steatotic liver disease (MASLD) in people with diabetes: the need for screening and early intervention. A consensus report of the American Diabetes Association. Diabetes Care 2025American Diabetes Association, 2025
- Vaz K et al. Fatty liver disease in Australia: a narrative review on the epidemiology, natural history, prognostication and management in people with metabolic dysfunction. Med J Aust 2026;224:e70195AU/NZMedical Journal of Australia, 2026
- Sanyal AJ et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis (ESSENCE). N Engl J Med 2025;392:2089-99New England Journal of Medicine, 2025
- Harrison SA et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis (MAESTRO-NASH). N Engl J Med 2024;390:497-509New England Journal of Medicine, 2024
- TGA prescription medicines registrations: Wegovy (semaglutide), MASH indication via the provisional approval pathway, decision 13 March 2026AU/NZTherapeutic Goods Administration, 2026
- Wegovy approved to treat severe fatty liver disease (TGA provisional approval for non-cirrhotic MASH, not PBS-listed)AU/NZRACGP newsGP, 1 April 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy