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

As obesity and type 2 diabetes 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 HCPLive. “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.

References

Brooks A. MASLD Prevalence Projected to Exceed 40% by 2050, Increasing Health System Burden. HCPLive. January 18, 2025. Accessed March 31, 2025. https://www.hcplive.com/view/masld-prevalence-projected-exceed-40-by-2050-increasing-health-system-burden