This handout is for masld / mash (formerly nafld/nash). Your care team identified this based on: incidentally elevated alt or hepatic steatosis on imaging.
Other reasons your team may use this plan: hepatic steatosis on us/ct/mri; elevated fib-4 score (≥1.3) on routine screening in at-risk population; known masld/nafld on problem list — follow-up or progression concern.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| lifestyle_weight_loss | ≥5% body weight loss for steatosis resolution; ≥7-10% for MASH/inflammation resolution; ≥10% for fibrosis regression | — | — | AASLD 2023 — weight loss is the most effective intervention; Mediterranean diet preferred; caloric deficit 500-1000 kcal/day; 150-300 min/week moderate-intensity exercise |
| bariatric_surgery | BMI ≥35 (or ≥30 with metabolic comorbidities) with MASH | — | — | AASLD 2023 — bariatric surgery achieves sustained weight loss and MASH resolution in most patients; observational evidence of fibrosis improvement |
Plan: Lifestyle intervention — cornerstone of MASLD treatment (AASLD 2023)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifestyle reinforcement; weight loss maintenance; medication adherence; cardiovascular risk reduction (leading cause of death in MASLD); HCC surveillance if cirrhotic; consideration of bariatric surgery if BMI ≥35 with MASH (AASLD 2023)
Guideline: AASLD 2023 Practice Guidance on Clinical Assessment and Management of NAFLD/MASLD + EASL 2024 Clinical Practice Guidelines on MASLD + Rinella Hepatology 2023 (nomenclature) + PIVENS (Sanyal NEJM 2010) + MAESTRO-NASH (Harrison NEJM 2024)