MASLD: non-alcoholic fatty liver disease associated with metabolic dysfunction
MASLD is defined as the presence of hepatic steatosis ≥ 5 per cent, combined with at least one criterion of metabolic dysfunction. This definition better reflects the metabolic aetiology of the disease and distinguishes MASLD from other causes of steatosis.
- Key features of MASLD
MASLD is often asymptomatic, which explains why it is underdiagnosed.1 Transaminase levels may be normal, which can give a false sense of reassurance.
The condition is strongly associated with metabolic factors such as:
– type 2 diabetes,
– obesity,
– dyslipidaemia,
– high blood pressure,
– metabolic syndrome.
MASLD is one of the leading causes of hepatic steatosis seen in clinical practice.2 Progression to MASH is possible, but not inevitable.
- Why is it important to detect MASLD at an early stage?
Because it is the first stage of a progressive disease. Early detection makes it possible to address metabolic factors and prevent progression to MASH, fibrosis and cirrhosis.
MASH: the inflammatory and progressive form of MASLD
MASH is characterised by steatosis associated with liver inflammation, hepatocyte ballooning and, in many cases, fibrosis. It is the active, progressive form of the disease.
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Key features of the MASH
MASH is associated with persistent inflammation, which accelerates the progression of fibrosis. It is often linked to severe metabolic comorbidities.
It can remain asymptomatic for years, which makes screening essential.
MASH is the form requiring the most active management, as it is associated with a high risk of complications: advanced fibrosis, cirrhosis and hepatocellular carcinoma.
MASLD vs MASH: the key differences
Although MASLD and MASH are part of the same continuum, their clinical implications are very different.
| MASLD | MASH | |
|---|---|---|
| Nature of the disease | Simple steatosis + metabolic dysfunction | Steatosis + inflammation + hepatocyte ballooning ± fibrosis |
| Risk of progression | Slow progression, often reversible | Progression towards fibrosis and cirrhosis |
| Clinical impact | Screening, prevention, and metabolic monitoring | Specialised management and close monitoring |
Beyond the terminology, distinguishing between MASLD and MASH is essential for guiding clinical management: this distinction determines both the patient’s level of risk and the intensity of follow-up, making early diagnosis a key factor in preventing progression to the most severe forms of the disease.
The role of the Echosens ecosystem in the management of MASLD/MASH
Echosens offers a range of solutions to support healthcare professionals in the management of liver diseases:
FibroScan® :
– LSM by VCTE® (Liver Stiffness Measurement) to measure liver stiffness and estimate the degree of fibrosis.
– CAP (Controlled Attenuation Parameter) to quantify steatosis.
– SSM by VCTE® (Spleen Stiffness Measurement) to indirectly assess portal hypertension.3
FibroScan®-based Scores, algorithms combining FibroScan® measurements with clinical and laboratory parameters:
– FAST: identification of patients at risk of MASH with significant activity and fibrosis.
– Agile 3+: detection of advanced fibrosis (≥ F3).
– Agile 4: identification of patients with cirrhosis.
The LHM platform: a cloud-based solution for longitudinal monitoring.
FibroScan® Gateway: secure transfer to the patient’s medical record.
In summary
This ecosystem enables comprehensive care, from screening to monitoring. In light of the MASLD–MASH continuum and the importance of early diagnosis, FibroScan® stands out as a key, non-invasive and scientifically validated tool, supported by over 6,270 publications and 250 international guidelines. It enables precise risk stratification and more proactive management, helping to effectively prevent progression to severe stages of the disease.
1 : Younossi, Zobair M et al. “Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.” Hepatology (Baltimore, Md.) vol. 64,1 (2016): 73-84.
2 : Chan, Wah-Kheong et al. “Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review.” Journal of obesity & metabolic syndrome vol. 32,3 (2023): 197-213.
3 : de Franchis, Roberto et al. “Baveno VII – Renewing consensus in portal hypertension.” Journal of hepatology vol. 76,4 (2022): 959-974.
Products in the FibroScan range are class IIa medical devices according to Rule 10 of ANNEX VIII of Regulation EU 2017/745 (CE 0459) and are manufactured by Echosens. FibroScan devices are intended to provide: Liver stiffness measurements at a shear wave frequency of 50 Hz, liver ultrasound attenuation measurements (CAP: Controlled Attenuation Parameter) at 3.5 MHz and spleen stiffness measurements at a shear wave frequency of 100 Hz (FibroScan 630 Expert only). These non-invasive devices are intended to aid clinical management, diagnosis, and monitoring of patients with confirmed or suspected chronic liver disease, as part of an overall assessment of the liver. FibroScan devices may aid the healthcare professionals in the assessment of liver fibrosis, steatosis, and in determining the likelihood of cirrhosis, and its complications (FibroScan 630 Expert only). They are used, in conjunction with other clinical and laboratory data, during liver assessment in patients with confirmed or suspected chronic liver disease. Examinations with FibroScan devices shall be performed by an operator who has been certified by the manufacturer or its approved local representative. Operators are expressly recommended to carefully read the instructions given in the user manual and on the labelling of these products. Check cost defrayal conditions with paying bodies. Fast is a class IIa medical device according to Rule 11 of Annex VIII of Regulation EU 2017/745 (CE 0459). Agile 3+ and Agile 4 are class I medical devices according to Directive 93/42/EEC. Fast, Agile 3+ and Agile 4 are manufactured by Echosens. Fast is an algorithm intended to aid in the diagnosis of active fibrotic Non-Alcoholic Steatohepatitis (NASH) in patients with suspected Non-Alcoholic Fatty Liver Disease (NAFLD). Fast is used, during liver assessment, in patient with suspected NAFLD. The following precautions must be observed when using Fast: LSM (also known as E) and CAP measurements must come from the same FibroScan examination; There must be no more than 6 months between the FibroScan examination and the blood sample necessary for AST assessment. Fast must not be used in the following situations : pregnancy, patients under 18 years old, chronic or acute liver diseases other than NAFLD, liver transplant patients, cardiac failure and/or significant vascular disease, confirmed diagnosis of active malignancy or other terminal disease, use of treatment inducing liver injury. Agile 3+ calculator is a tool for clinicians, computed from LSM (obtained from FibroScan device), AST, ALT, platelets, diabetes status, age and gender, to aid in the identification of patients with suspicion of NAFLD as having advanced fibrosis. It was developed based on a pool of retrospective cohorts and published in peer-reviewed literature. Agile 4 calculator is a tool for clinicians, computed from LSM (obtained from FibroScan device), AST, ALT, platelets, diabetes status and gender, to aid in the identification of patients with suspicion of NAFLD as having cirrhosis. It was developed based on a pool of retrospective cohorts and published in peer-reviewed literature. Fast, Agile 3+ and Agile 4 are presented as educational services intended for licensed healthcare professionals. While these scores are about specific medical and health issues,they are not a substitute for or a replacement of personalized medical advice and are not intended to be used as the sole basis for making individualized medical or health-related decisions. Users are expressly recommended to carefully read the instructions given in the user manual. User manual is available on the Score interface or Echosens website. To access, please make sure to be connected to the internet.
