Lifestyle Factors Offer Actionable Targets in MASLD Management: Zobair M. Younossi, MD

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in the highest tertile of ultra-processed food intake had nearly twice the prevalence of advanced fibrosis compared with those in the lowest tertile, according to data presented at the European Association for the Study of the Liver Congress in May 2026.

In the fourth and final installment of his interview with The American Journal of Managed Care^®, Zobair M. Younossi, MD, chairman of the Global NASH Council, addressed how actionable this finding is for US clinicians managing patients with MASLD.

Younossi said clinicians currently do not pay enough attention to what patients with MASLD actually eat, positioning diet as an underused, immediately actionable lever. He described MASLD as a complex disease shaped by both genetic and environmental factors. Although genetic risk is fixed at birth, he emphasized that its effects can be amplified in the wrong environment, meaning dietary intervention may still influence disease trajectory even among genetically predisposed patients.

Younossi offered a practical “rule of thumb” clinicians can use with patients to help them identify ultra-processed foods.

“If you look at what you eat, in terms of preservatives and anything else that's actually in the food that you eat, and you don't have that in your kitchen, you know that you have a lot of ultra-processed foods,” he said.

He suggested that this benchmark can make dietary counseling more actionable during routine visits than abstract nutrition guidance.

Beyond diet, Younossi pointed to alcohol consumption as another frequently underreported contributor. He estimated that it affects 10% to 15% of patients with MASLD and that even moderate intake can worsen the disease.

He also highlighted the impact of physical activity. Framing the issue around how patients use the 24 hours in a day, Younossi emphasized that replacing sedentary time with quality sleep or vigorous activity can help shift a patient's disease trajectory.

Overall, his comments reinforce the importance of addressing lifestyle factors alongside pharmacologic management in MASLD. In particular, counseling patients about ultra-processed food, alcohol consumption, and physical activity offers clinicians actionable strategies for addressing modifiable factors that may influence disease progression.