Rewriting the MASLD playbook
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD) and often referred to simply as fatty liver disease, is not just a liver issue. It’s a systemic metabolic condition that demands a fundamental shift in how we identify, treat, and manage it. For too long, MASLD care has relied on a narrow playbook: lifestyle advice, routine monitoring, and waiting for signs of progression. But new evidence is rewriting the rules, and the message is clear – early, comprehensive intervention is key to better outcomes.
MASLD affects an estimated 30%[1] of the global adult population and is projected to impact more than 55%[2] worldwide by 2040. It is closely linked to metabolic dysfunctions like diabetes, obesity, dyslipidaemia, and cardiovascular disease and, when left unchecked, it progresses silently to fibrosis, cirrhosis, and hepatocellular carcinoma. Yet, the burden of MASLD extends far beyond the liver. Patients often experience a constellation of symptoms: fatigue, abdominal pain, sleep issues, and bloating – symptoms that disrupt daily life long before advanced liver disease develops.
The problem? MASLD is being diagnosed too late or not diagnosed at all, meaning patients are treated too late. Viewing it as a systemic metabolic disorder, rather than a standalone liver condition, changes everything. Effective care now requires identifying metabolic risks early and addressing the broader factors driving liver damage. This means moving beyond enzyme monitoring and weight loss advice to a patient-centred, multidisciplinary approach.
The shift to early, layered interventions
New evidence is driving a shift from reactive to proactive care. Instead of waiting for abnormal liver enzymes or fibrosis to appear, clinicians are focusing on early detection and comprehensive management. This includes:
- Coordinated care: Addressing cardiometabolic risk factors like obesity, diabetes, and dyslipidaemia in tandem with liver health.
- Emerging treatments: Incorporating pharmacological options alongside structured behavioural support.
- Advanced monitoring tools: Non-invasive technologies like elastography and controlled attenuation parameter (CAP) scores make early diagnosis more accessible, reducing reliance on biopsies.
- Patient-reported outcomes: Understanding how MASLD affects energy, sleep, and daily function allows for more personalised care.
This evolving model shifts the focus from “lifestyle first, escalate later” to a dynamic, patient-centred approach that adapts as the disease progresses.
The role of pharmacists and collaborative care
Pharmacists are uniquely positioned to close the gap in MASLD care. As accessible and trusted healthcare professionals, they frequently interact with patients managing obesity, diabetes, and other conditions that drive MASLD progression. Their role extends beyond dispensing medication – they can reinforce lifestyle changes, monitor adherence, and educate patients on the connection between metabolic health and liver disease. By intervening earlier and collaborating with primary care and specialists, pharmacists help ensure MASLD is addressed proactively, not reactively.
Timing is critical. Up to 80% of patients with early-stage MASLD can reverse liver fat when metabolic risks are managed effectively. But, too often, interventions begin only after significant liver damage has occurred. Real-world evidence and risk stratification tools now enable clinicians to identify high-risk patients earlier and tailor interventions for maximum impact.
Redefining success in MASLD care
Managing MASLD isn’t just about improving liver enzymes – it’s about improving lives. Fatigue, low energy, and cognitive difficulties are common, but often overlooked. Incorporating patient-reported outcomes into routine care helps clinicians address these real-life challenges. Simple questions about how patients feel and function can uncover unmet needs and guide more meaningful interventions.
Self-care and ongoing engagement are central to long-term success. While weight loss remains important, reducing overall disease burden and improving quality of life are equally critical. Collaborative care – where patients, pharmacists, and clinicians work together – makes interventions practical and sustainable. Pharmacists can flag early warning signs, while clinicians adjust treatment plans and address comorbidities. Together, they empower patients to take an active role in their care.
The new MASLD playbook
The MASLD playbook is being rewritten, and the central strategy is clear: identify risk early, intervene early, and measure outcomes that matter to patients. This means asking better questions, recognising metabolic risk patterns, and empowering patients to participate actively in their care. When evidence-based interventions are combined with patient-centred care, the benefits are tangible. Patients don’t just see better test results – they feel more energy, think more clearly, and function better in daily life.
MASLD care is at a turning point. It’s not just a liver condition – it’s a visible signal of systemic metabolic dysfunction. Treating it as such changes how we intervene, how specialties collaborate, and how success is defined. The question is no longer whether we have enough evidence, but whether we are ready to act on it.
References
[1] Miao, L., Targher, G., Byrne, C. D., Cao, Y.-Y., & Zheng, M.-H. (2024). Current status and future trends of the global burden of MASLD. Trends in Endocrinology & Metabolism, 35(8), 697–707. https://doi.org/10.1016/j.tem.2024.02.007
[2] https://e-cmh.org/journal/view.php?doi=10.3350/cmh.2024.0431
About the author
Nikunj Thakker is global general manager of Opella, leading the global development and scientific direction of a liver care brand. He has nearly two decades of experience in consumer healthcare supported by a strong pharmacy background, with extensive leadership experience across allergy, pain relief, digestive wellness, probiotics, VMS, and liver care at Sanofi CHC. Thakker holds a Bachelor of Pharmacy and an MBA in Pharmaceutical Marketing and Management. He believes that early action and clear science can change the future of liver health.
