EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Summary

This joint European clinical practice guideline (EASL-EASD-EASO) provides updated recommendations for managing metabolic dysfunction-associated steatotic liver disease across its full spectrum. The guideline recommends a stepwise diagnostic approach using blood-based non-invasive tests and imaging in at-risk populations, combined with lifestyle modification as first-line treatment, optimisation of cardiometabolic comorbidities using incretin-based agents, and consideration of resmetirom for non-cirrhotic MASH with significant fibrosis. The evidence synthesis suggests that integrated management addressing both liver and metabolic dysfunction yields improved outcomes.

Regional applicability

As a European consensus guideline, the recommendations are directly applicable to United Kingdom clinical practice and healthcare systems. The guideline's emphasis on nutritional and lifestyle management aligns with UK policy frameworks on metabolic disease prevention and management, though local implementation may require adaptation to NHS structures and available resources.

Key measures

Diagnostic accuracy of non-invasive tests (FIB-4, transient elastography); histological effectiveness of resmetirom on steatohepatitis and fibrosis; weight loss and metabolic outcomes from lifestyle modification and pharmacotherapy

Outcomes reported

The guideline reports recommendations for MASLD case-finding, diagnosis and management across the disease spectrum from steatosis to cirrhosis and hepatocellular carcinoma. It evaluated evidence for non-invasive diagnostic approaches, lifestyle interventions, pharmacological treatments including incretin-based therapies and resmetirom, and bariatric surgery.

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