Christos Mantzoros, MD, DSc, PhD, is a professor of medicine at Harvard Medical School, chief of endocrinology, diabetes and metabolism at the Boston VA Healthcare System, and director of human nutrition at Beth Israel Deaconess Medical Center.

Christos Mantzoros, MD, DSc, PhD

The Future of MASLD Management, with Christos Mantzoros, MD, Dsc, PhD

 continue to rise globally, so does the prevalence of 

metabolic dysfunction-associated steatotic liver disease (MASLD)

. Once considered primarily a hepatic concern, MASLD is increasingly being recognized as a metabolic disease whose management requires a multidisciplinary approach.

With an estimated 30% of the population currently affected and many more expected in coming years, effectively managing MASLD demands expertise across specialties beyond hepatology. Findings from a recent decision analytical modeling study suggest the prevalence of MASLD could reach 41.4%, equating to approximately 122 million people in the US, by 2050, accompanied by stark increases in prevalent cases of decompensated cirrhosis, incident cases of liver cancer, and the need for liver transplantation.

“I don't think we have enough experts to treat [these patients],” Christos Mantzoros, MD, DSc, PhD, a professor of medicine at Harvard Medical School, chief of endocrinology, diabetes and metabolism at the Boston VA Healthcare System, and director of human nutrition at Beth Israel Deaconess Medical Center, told 

. “We need to develop them and train them… I think we need collaboration between specialists, we need education, and we need professional societies to start talking to each other and creating those overlapping areas by creating bridges.”

Mantzoros goes on to emphasize the importance of lifestyle modification and its role as the foundation of MASLD management, noting it must be established before initiating pharmacologic therapy. He says that without diet and exercise, medications will not reach their full therapeutic potential.

“We have preliminary evidence that some of these medications may have more activity in the liver,” Mantzoros explained. “This remains to be fully proven, but not all GLPs are going to be equal, and I think some of them will be more liver-specific. So this is where we are moving to: lifestyle modification, different medications with different strengths, but also different activity at the level of the liver.”

Mantzoros expresses optimism about the potential of weight loss medications for the treatment of MASLD, drawing a parallel to the transformative impact seen with the advent of antivirals for hepatitis C. By eliminating excess fat accumulation in the liver, he says these therapies may effectively reduce inflammation and fibrosis.

“Only time will show whether I'm right, but this is my prediction today, and I don't think I'm too optimistic. This will be great for our patients,” he said.

Editors’ note: Mantzoros has relevant disclosures with Nestlé, Olympus, Genfit, Lumos, Novo Nordisk, Amgen, Corcept, Intercept, 89Bio, Madrigal, Aligos, Esperion, Regeneron, and others.

Brooks A. MASLD Prevalence Projected to Exceed 40% by 2050, Increasing Health System Burden. 

. January 18, 2025. Accessed March 31, 2025. 

https://www.hcplive.com/view/masld-prevalence-projected-exceed-40-by-2050-increasing-health-system-burden

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Mantzoros explains the need for multidisciplinary MASLD care and how to balance lifestyle modifications with emerging medications.

Shifting Toward Multidisciplinary MASLD Care, with Christos Mantzoros, MD, DSc, PhD

 and the understanding of its overlap with 

 is evolving rapidly, with several recent advancements underscoring the need for a multidisciplinary approach to care in this patient population.

While hepatologists have historically been responsible for managing patients with MASLD, its growing prevalence will require assistance from clinicians from other specialties, especially as MASLD increasingly becomes recognized as a metabolic disease rather than just a liver disease.

A recent decision analytical modeling study estimated the prevalence of MASLD would reach 41.4%, equating to approximately 122 million people in the US, in 2050, accompanied by stark increases in prevalent cases of decompensated cirrhosis, incident cases of liver cancer, and the need for liver transplantation.

“I think it's a confluence of factors that led to an epidemic of MASLD that, to a certain extent, has gone unrecognized by primary care doctors and endocrinologists,” Christos Mantzoros, MD, DSc, PhD, a professor of medicine at Harvard Medical School, chief of endocrinology, diabetes and metabolism at the Boston VA Healthcare System, and director of human nutrition at Beth Israel Deaconess Medical Center, explained to 

, going on to describe the interplay between obesity, insulin resistance, diabetes, fat accumulation in the liver, and MASLD.

He says that with new therapeutic options in the treatment armamentarium, including GLP-1 receptor agonists and the recently approved resmetirom (Rezdiffra), there are an increasing number of opportunities to address the metabolic drivers of MASLD, reduce liver fat, and prevent progression to fibrosis.

“Until recently, this was confined to hepatology…. [but] they cannot take care of the entire community,” Mantzoros said, emphasizing the importance of educating endocrinologists so they can better assist in MASLD care. “In my opinion, we need to create subspecialties, the same way we have osteoporosis experts or thyroid experts. Now we have a thyroid receptor beta for the liver, so we need a subspecialty in endocrinology for the liver.”

Additionally, he says primary care doctors must also be aware of what is happening and what tools they have at their disposal to diagnose and treat MASLD.

“Collectively, we have not been paying attention to the liver or diagnosing, but now we have noninvasive tests. We can diagnose it, and we should diagnose it,” Mantzoros emphasized, citing the large number of patients in endocrinology clinics who have liver disease and clinicians’ ability to manage it with both lifestyle interventions and medications.

He notes that while endocrinologists are “not yet up to speed” with prescribing resmetirom and may feel more comfortable referring to a hepatologist, multidisciplinary care will be necessary in the future, and care will need to be coordinated between specialties.

. January 18, 2025. Accessed March 28, 2025. 

Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. 

. March 14, 2024. Accessed March 28, 2025. 

https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

Mantzoros explains factors contributing to the growing burden of MASLD and the need for collaboration between hepatology, primary care, and endocrinology.

Christos Mantzoros, MD, DSc, PhD

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