Nutrition’s Role in MASH, Cirrhosis Management, with Tessa Janovsky, PA-C

Prior to the US Food and Drug Administration approval of resmetirom (Rezdiffra), the first liver-directed metabolic dysfunction-associated steatohepatitis (MASH) therapeutic, weight loss served as the cornerstone of disease management.

Even with a pharmacologic treatment now available for patients with noncirrhotic MASH, weight loss continues to be an important facet of disease management, with diet and nutrition playing an especially significant role in influencing patient outcomes.

In a presentation at the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) conference in National Harbor, Maryland, Tessa Janovsky, PA-C, a physician assistant at Arizona Liver Health, reviewed the role nutrition plays in MASH and cirrhosis management, describing it as “one of the most important things to discuss with a patient” in an interview with HCPLive.

“Nutrition really can guide outcomes, especially with MASH when we talk about the need to adjust the diet, lower the sugar intake, lower the carbohydrate intake. That's all going to be vital for the liver in the long run, to deburden the amount of carbs and sugar that the liver is processing,” she explained. “When we talk about cirrhosis, nutrition can kind of make or break a patient outcome… As best as we can optimize our patient nutritionally, we're going to set them up for more success down the line, hopefully, when it comes to their liver, morbidity, and mortality.”

Janovsky described the best dietary intervention as one that patients are able to adhere to, something she noted looks different for everybody and is not a “one size fits all” approach. Specifically, she called attention to cultural differences in diet that may influence the way a patient eats and what nutritional changes will be most realistic for them relative to the diet they are used to.

Acknowledging both pharmaceuticals and nutrition as mainstays of therapy, Janovsky pointed out resmetirom is approved in conjunction with diet and physical activity. She also cited the benefits of diet and exercise in patients with more advanced liver disease who are not currently candidates for resmetirom. For diet and nutrition in particular, Janovsky emphasized the importance of a multidisciplinary approach with endocrinologists and nutritionists.

“[Diet] can be a touchy subject for a lot of patients,” she said. “Even if you have 5 extra minutes with a patient, just talking to them and kind of figuring out what works for them, patients really do appreciate that. I want to encourage providers to think outside the box as far as what relates more to the patient.”

References

1. ^{Brooks, A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed September 12, 2024. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash}
2. ^{Brooks, A. Stephen Harrison, MD: The Role of Weight Loss, Resmetirom in NASH Management. HCPLive. March 18, 2024. Accessed September 12, 2024. https://www.hcplive.com/view/stephen-harrison-md-weight-loss-resmetirom-nash-management}