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

The management of metabolic dysfunction-associated steatotic liver disease (MASLD) and the understanding of its overlap with obesity and type 2 diabetes 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.1

“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 HCPLive, 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.2

“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.

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

References

1. Brooks A. MASLD Prevalence Projected to Exceed 40% by 2050, Increasing Health System Burden. HCPLive. January 18, 2025. Accessed March 28, 2025. https://www.hcplive.com/view/masld-prevalence-projected-exceed-40-by-2050-increasing-health-system-burden

2. Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed March 28, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash