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Updated: Apr 10, 2026

Optimized Analysis of In Vivo and In Vitro Hepatic Steatosis
Published on: March 11, 2017
Updated Global Consensus Recommendations for Risk Stratification, Treatment Initiation, and Response Monitoring in
Zobair M Younossi1, Markos Kalligeros2, Vincent Wai-Sun Wong3
1The Global NASH/MASH Council, Washington, District of Columbia; Global Center for Liver Outcomes and Policy Research, Georgetown University School of Medicine, Washington, District of Columbia.
Updated guidelines recommend using noninvasive tests for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD). New algorithms integrate these tests with approved therapies like resmetirom and semaglutide for better patient care.
Area of Science:
- Hepatology
- Endocrinology
- Gastroenterology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) are rising globally, linked to obesity and type 2 diabetes.
- MASLD with significant fibrosis (≥F2) increases the risk of adverse liver outcomes.
- Recent approvals of resmetirom and semaglutide necessitate updated clinical guidance.
Purpose of the Study:
- To provide updated consensus recommendations for MASLD risk stratification, treatment initiation, and response monitoring.
- To integrate noninvasive tests (NITs) with newly approved pharmacologic therapies.
- To standardize care for patients with MASLD and significant fibrosis.
Main Methods:
- A structured Delphi process involving 40 international experts from hepatology, gastroenterology, endocrinology, internal medicine, and primary care.
- Systematic literature review (January-November 2025) updated since previous consensus.
- Consensus defined as ≥70% agreement, with iterative anonymous voting.
Main Results:
- 86% of 42 developed statements reached consensus in the first round; all reached consensus after refinement.
- Endorsed sequential risk stratification starting with FIB-4, followed by elastography or Enhanced Liver Fibrosis (ELF) testing.
- Supported resmetirom or semaglutide for noncirrhotic MASH (F2-F3) with specific NIT values; combination therapy not recommended upfront.
Conclusions:
- This consensus offers practical algorithms for integrating NITs and new pharmacologic therapies for MASLD.
- Addresses current variability in clinical practice for MASLD management.
- Supports standardized, risk-based care implementation for MASLD patients.
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