Screening, Risk Stratification, and the Multidisciplinary Care Model for MASH

In this episode, 'Screening, Risk Stratification, and the Multidisciplinary Care Model for MASH,' the hepatologist Nadege Gunn, MD explores the following questions:

1. How would you characterize the urgency of MASH as a public health problem for a primary care physician who may see the early signs?
2. In an ideal world, what does the multidisciplinary care model for a MASH patient with significant obesity look like? How far is current clinical practice from that ideal, and where do the current gaps exist?

Gunn characterized MASH as a genuine public health threat, noting that metabolic dysfunction-associated steatotic liver disease (MASLD) affects 30% or more of the population in the United States and worldwide, with a significant subset at risk for advanced fibrosis and downstream complications including cardiovascular disease and liver-related morbidity and mortality, making it imperative that every primary care clinician who interacts with a patient first is equipped to recognize risk factors, know who to screen, understands screening frequency, and responds appropriately to abnormal non-invasive test results. She also outlined what an ideal multidisciplinary care model for MASH patients with obesity looks like in practice, describing a care ecosystem anchored by a knowledgeable primary care clinician at the foundation, supported by specialists in endocrinology, obesity medicine, cardiology, bariatric surgery, physical therapy, and nutrition, while acknowledging that this level of coordinated care is far from universally available and varies significantly based on geography, care setting, and available resources. Gunn further shared how her own community-based practice has worked to approximate this ideal, building a team that includes obesity-certified clinicians, a nurse practitioner, and access to dietitians and nutritionists, while also investing heavily in disease awareness education for the surrounding primary care community so that appropriate patients are identified and referred before their disease progresses.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Screening MASH Upstream: Building a Practical, Scalable Algorithm for the Real World,' features Nadege Gunn advancing her conversation on obesity and MASH and focusing on what a practical, scalable MASH screening algorithm looks like.