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 characterized 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 | Specialized 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.
The FibroScan device (Models: 502 Touch, 530 Compact, 430 Mini+, 230, and 630) is intended to measure liver stiffness (E) using Vibration Controlled Transient Elastography (VCTE) at 50 Hz shear wave frequency and liver ultrasound attenuation coefficient (CAP)* at 3.5 MHz. FibroScan 630 Expert is also intended to measure spleen stiffness using VCTE at 100 Hz shear wave frequency. FibroScan liver stiffness measurements (LSM) by VCTE may aid the physician in determining the likelihood of cirrhosis and may be used, taken in context with other clinical and laboratory data, as an aid in the assessment of liver fibrosis. FibroScan CAP measurements may be used, taken in context with other clinical and laboratory data, as an aid in the assessment of hepatic steatosis. FibroScan is indicated as a non-invasive aid for the clinical management, diagnosis, and monitoring of adult and pediatric patients with confirmed or suspected liver disease, as part of an overall assessment of the liver. Results in the pediatric population should be interpreted while considering the clinical condition and the overall patient profile. The FibroScan device is intended for use by healthcare professionals in hospitals, clinics or any facility where healthcare is provided. *CAP refers to ultrasound attenuation coefficient (originally defined as Controlled Attenuation Parameter). CAP on S+ probe is only available with SmartExam capability.The Fast, Agile 3+ and Agile 4 calculators are tools for clinicians that are intended to compute the Fast, Agile 3+ and Agile 4 scores, respectively. The Fast score is a tool for clinicians, computed from LSM and CAP (obtained from FibroScan device) and AST blood parameter measurement, to aid in the identification of a patient with suspicion of NAFLD as being at risk for active fibrotic NASH. (NASH+NAS≥4+F≥2). It was developed based on a prospective multicenter cohort and published in peer-reviewed literature.The Agile 3+ score 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. The Agile 4 score 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. The Fast, Agile 3+ and Agile 4 calculators 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.
