Screening and management of metabolic dysfunction-associated steatotic liver disease (MASLD)

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is an increasingly prevalent condition that poses significant public health challenges. Affecting nearly 30% of the global population, MASLD is intricately linked to metabolic syndrome, insulin resistance, and cardiovascular disease. Primary care providers, including physician associates (PAs), play a critical role in early detection and management. This article provides an updated overview of MASLD for primary care PAs, focusing on disease pathophysiology, risk stratification, and screening recommendations. The use of noninvasive testing (eg, FIB-4, liver stiffness measurement) for diagnosis and monitoring is emphasized, and lifestyle interventions are underscored as first-line therapy. Importantly, the article highlights the recent FDA approval of resmetirom-the first pharmacologic treatment for noncirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis-and outlines the AASLD guideline supporting its use without the need for liver biopsy. By equipping primary care physician associates with current knowledge and practical tools, this article aims to improve early identification, guide appropriate referral, and enhance outcomes for patients at risk for MASLD progression. It also provides guidance around use of resmetirom in primary care, reviewing the drug's indications, dosing, drug-drug interactions, and safety monitoring. Finally, it highlights semaglutide as an emerging treatment option for noncirrhotic MASH.