Editor’s Note: At the recently concluded international annual grand event in the field of hepatology – the American Association for the Study of Liver Diseases Annual Meeting (AASLD 2023), Professor Monica Tincopa from the University of California, San Diego, was invited to present in the session “Patient-centered Management of Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD)”. She discussed the current state of MASLD management and shared four new insights into the management of MASLD in the new era during an exclusive interview with “Hepatology Digest” after the conference. The interview video and the bilingual interview transcript are shared below.
1. Empowering Patients to Actively Manage MASLD
Hepatology Digest: How can patients perceive and actively manage MASLD themselves to alleviate the condition and prevent further deterioration?
Professor Monica Tincopa: From the patient-centered MASLD management session, we can summarize that the primary thing for patients and caregivers is to understand the disease-related knowledge. For instance, why is it important to pay attention to MASLD? Often, patients are only diagnosed with chronic liver disease and advised to lose weight. To better understand and accept weight loss treatments, patients need to comprehend what a MASLD diagnosis means, its long-term impact, and the signs and symptoms to watch for.
What specific foods and lifestyles might help or affect the patient’s condition? I believe once they understand these things better, patients can become their own best supporters, knowing when they need extra exercise, what to focus on in difficult times, and what kinds of activities they can engage in during their free time.
2. Caregivers Understanding Disease Stages and Creating a Healthy Lifestyle Environment
Hepatology Digest: How can caregivers provide personalized care and support for MASLD patients’ special needs?
Professor Monica Tincopa: From the caregiver’s perspective, it largely depends on the stage of the disease. At the conference, we heard from a caregiver of a severe patient. Once the patient develops cirrhosis and complications, caregiving becomes very challenging. Patients often need frequent hospital admissions and discharges, liver transplant evaluations, and endure the anxiety of waiting for a transplant.
Understanding the stage of the patient’s illness and helping them improve their lifestyle can greatly assist the patient. Data shows that people can better change their diet and maintain exercise if those around them are doing the same. So, I think this is a key task for caregivers, at least in the early stages of the disease. As the patient’s condition progresses, there will be more to do, like ensuring they attend doctor appointments, follow medication orders, and keep up with subsequent treatments.
3. Training for Related Department Physicians and Promoting Non-Invasive Assessment Methods
Hepatology Digest: How can healthcare professionals effectively manage and treat MASLD patients using existing diagnostic tools and treatment methods?
Professor Monica Tincopa: This field is constantly evolving with new studies and breakthroughs. As discussed at the conference, there were no screening recommendations for MASLD before this year. We didn’t have the right algorithms, but now we do. A big challenge is educating primary care providers and other specialists who see these patients, such as cardiologists and endocrinologists, providing them with tools and knowledge about which patients to focus on.
I think educating and implementing non-invasive testing is relatively easy, but there’s still a lot of work to be done. For instance, how can we make it easier for clinicians to use existing tools to identify patients who need referral for MASLD treatment? From a referral perspective, getting patients into appropriate treatments is challenging. Currently, we have developed an algorithm that can be automatically calculated based on electronic health records.
Actively Addressing the Challenges of Renaming and Continuously Optimizing Management Processes
Hepatology Digest: Are current MASLD management guidelines and treatment strategies fully applied in practice? What challenges and controversies still exist?
Professor Monica Tincopa: As I said, our goals in this field are constantly evolving. I think there’s still quite a bit of work to be done. To some extent, the challenges we face are not only understanding and mastering all screening and risk stratification methods but also dealing with the new patient categorization after renaming “Non-Alcoholic Fatty Liver Disease (NAFLD)” to “Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)”.
Educating primary care and referral providers about NAFLD and Non-Alcoholic Steatohepatitis (NASH) was already difficult, and now with the renaming to MASLD and Metabolic Associated Steatohepatitis (MASH), it has further increased the difficulty in spreading knowledge. Nevertheless, I believe it is very necessary. Without understanding MASLD, often they ask, “Whom should I focus on?”, “What tests should I arrange?”, “How should I explain this test to the patient?”. So, I think, under our current guidelines, patients, doctors, and caregivers can get more advice and help. But in terms of clinical management processes, there is still a need for continuous optimization.
