A multinational expert panel has released a unified set of consensus recommendations to harmonize conflicting guidance on metabolic dysfunction–associated steatotic liver disease (MASLD) and steatohepatitis (MASH). 

The recommendations cover screening and risk stratification, with physicians advised to focus on high-risk patients, including those with type 2 diabetes, obesity plus another cardiometabolic risk factor, or persistent aminotransferase elevations. A noninvasive testing pathway includes FIB-4 for initial triage, followed by vibration-controlled transient elastography (VCTE) or another NIT to confirm fibrosis severity. Patients with liver stiffness values suggesting advanced fibrosis warrant specialist referral, while cirrhosis must be carefully excluded before treatment initiation.

Pharmacotherapy guidance includes resmetirom, the first FDA-approved therapy for noncirrhotic MASH with F2–F3 fibrosis, with eligibility and monitoring determined by NITs. Treatment should begin only after cirrhosis is excluded, with safety checks at 3, 6, and 12 months and efficacy judged at 12 months by NIT-based improvement, particularly ≥30% reduction in liver stiffness. The panel also recommends prioritizing GLP-1 receptor agonists in patients with diabetes or obesity, while advising against routine vitamin E use given limited benefit and safety concerns.