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Role of Non-invasive Biomarkers in the Evaluation and Management of MASLD
References
  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520

  2. Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology. 2023;165(4):1080-1088. doi:10.1053/j.gastro.2023.06.013

  3. Di Mauro S, Scamporrino A, Filippello A, et al. Clinical and Molecular Biomarkers for Diagnosis and Staging of NAFLD. Int J Mol Sci. 2021;22(21):11905. Published 2021 Nov 2. doi:10.3390/ijms222111905

  4. Hsu C, Caussy C, Imajo K, et al. Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants. Clin Gastroenterol Hepatol. 2019;17(4):630-637.e8. doi:10.1016/j.cgh.2018.05.059

  5. Ilagan-Ying YC, Banini BA, Do A, Lam R, Lim JK. Screening, Diagnosis, and Staging of Non-Alcoholic Fatty Liver Disease (NAFLD): Application of Society Guidelines to Clinical Practice. Curr Gastroenterol Rep. 2023;25(10):213-224. doi:10.1007/s11894-023-00883-8

  6. Chen W, Gao Y, Xie W, et al. Genome-wide association analyses provide genetic and biochemical insights into natural variation in rice metabolism. Nat Genet. 2014;46(7):714-721. doi:10.1038/ng.3007

  7. Wu YL, Kumar R, Wang MF, et al. Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease. World J Gastroenterol. 2021;27(34):5753-5763. doi:10.3748/wjg.v27.i34.5753

  8. Kaneva AM, Bojko ER. Fatty liver index (FLI): more than a marker of hepatic steatosis. J Physiol Biochem. Published online October 25, 2023. doi:10.1007/s13105-023-00991-z

Author and Disclosure Information

Julia J. Wattacheril, MD, MPH
Associate Professor
Department of Medicine
Director, MASLD Program
Division of Digestive and Liver Disease
Center for Liver Disease and Transplantation
Columbia University Irving Medical Center
New York Presbyterian Hospital
New York, New York

Disclosures:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AlphaSights, GlaxoSmithKline
Received research grant from: Galectin Therapeutics; Intercept Pharmaceuticals; AMRA Medical

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Author and Disclosure Information

Julia J. Wattacheril, MD, MPH
Associate Professor
Department of Medicine
Director, MASLD Program
Division of Digestive and Liver Disease
Center for Liver Disease and Transplantation
Columbia University Irving Medical Center
New York Presbyterian Hospital
New York, New York

Disclosures:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AlphaSights, GlaxoSmithKline
Received research grant from: Galectin Therapeutics; Intercept Pharmaceuticals; AMRA Medical

Author and Disclosure Information

Julia J. Wattacheril, MD, MPH
Associate Professor
Department of Medicine
Director, MASLD Program
Division of Digestive and Liver Disease
Center for Liver Disease and Transplantation
Columbia University Irving Medical Center
New York Presbyterian Hospital
New York, New York

Disclosures:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for:
AlphaSights, GlaxoSmithKline
Received research grant from: Galectin Therapeutics; Intercept Pharmaceuticals; AMRA Medical

References
  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520

  2. Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology. 2023;165(4):1080-1088. doi:10.1053/j.gastro.2023.06.013

  3. Di Mauro S, Scamporrino A, Filippello A, et al. Clinical and Molecular Biomarkers for Diagnosis and Staging of NAFLD. Int J Mol Sci. 2021;22(21):11905. Published 2021 Nov 2. doi:10.3390/ijms222111905

  4. Hsu C, Caussy C, Imajo K, et al. Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants. Clin Gastroenterol Hepatol. 2019;17(4):630-637.e8. doi:10.1016/j.cgh.2018.05.059

  5. Ilagan-Ying YC, Banini BA, Do A, Lam R, Lim JK. Screening, Diagnosis, and Staging of Non-Alcoholic Fatty Liver Disease (NAFLD): Application of Society Guidelines to Clinical Practice. Curr Gastroenterol Rep. 2023;25(10):213-224. doi:10.1007/s11894-023-00883-8

  6. Chen W, Gao Y, Xie W, et al. Genome-wide association analyses provide genetic and biochemical insights into natural variation in rice metabolism. Nat Genet. 2014;46(7):714-721. doi:10.1038/ng.3007

  7. Wu YL, Kumar R, Wang MF, et al. Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease. World J Gastroenterol. 2021;27(34):5753-5763. doi:10.3748/wjg.v27.i34.5753

  8. Kaneva AM, Bojko ER. Fatty liver index (FLI): more than a marker of hepatic steatosis. J Physiol Biochem. Published online October 25, 2023. doi:10.1007/s13105-023-00991-z

References
  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520

  2. Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA Clinical Practice Update on the Role of Noninvasive Biomarkers in the Evaluation and Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology. 2023;165(4):1080-1088. doi:10.1053/j.gastro.2023.06.013

  3. Di Mauro S, Scamporrino A, Filippello A, et al. Clinical and Molecular Biomarkers for Diagnosis and Staging of NAFLD. Int J Mol Sci. 2021;22(21):11905. Published 2021 Nov 2. doi:10.3390/ijms222111905

  4. Hsu C, Caussy C, Imajo K, et al. Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants. Clin Gastroenterol Hepatol. 2019;17(4):630-637.e8. doi:10.1016/j.cgh.2018.05.059

  5. Ilagan-Ying YC, Banini BA, Do A, Lam R, Lim JK. Screening, Diagnosis, and Staging of Non-Alcoholic Fatty Liver Disease (NAFLD): Application of Society Guidelines to Clinical Practice. Curr Gastroenterol Rep. 2023;25(10):213-224. doi:10.1007/s11894-023-00883-8

  6. Chen W, Gao Y, Xie W, et al. Genome-wide association analyses provide genetic and biochemical insights into natural variation in rice metabolism. Nat Genet. 2014;46(7):714-721. doi:10.1038/ng.3007

  7. Wu YL, Kumar R, Wang MF, et al. Validation of conventional non-invasive fibrosis scoring systems in patients with metabolic associated fatty liver disease. World J Gastroenterol. 2021;27(34):5753-5763. doi:10.3748/wjg.v27.i34.5753

  8. Kaneva AM, Bojko ER. Fatty liver index (FLI): more than a marker of hepatic steatosis. J Physiol Biochem. Published online October 25, 2023. doi:10.1007/s13105-023-00991-z

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Role of Non-invasive Biomarkers in the Evaluation and Management of MASLD
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Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD),1 refers to a range of liver conditions characterized by the accumulation of fat in the liver due to metabolic factors. MASLD affects nearly 30% of the global population and is a prevalent cause of advanced liver disease.2 This disease can progress from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), which involves inflammation and liver cell damage—and unmitigated can lead to liver cirrhosis, liver failure, and liver cancer.

Clinicians' early identification and stratification of at-risk individuals may impact progression and regression, as only a minority of individuals with MASLD present with liver-related consequences.2 Although early identification and risk stratification may occur in gastroenterology and hepatology clinics, disease modifying interventions may occur outside of those settings. Continuously monitoring MASLD response to current treatments is also key. Histologic examination of the liver is the current established standard for assessing and monitoring this disease, grading necroinflammation, and staging hepatic fibrosis; however, the cost and invasiveness limit its routine and widespread use.2 Drug approvals independent of histology-based outcomes lay the groundwork for further standardization and validation of noninvasive tests (NITs) in the evaluation and management of MASLD. The latest AGA Clinical Practice Update (2023) can help healthcare professionals use NITs to identify patients who are at higher risk for MASLD progression for directed intervention.2 Ongoing research continues to refine the use of NITs in evaluating and managing MASLD; therefore, the landscape is likely to evolve and advance over time.

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