The Obesity-MASH Burden: What the Numbers Tell Us and How to Screen More Effectively

In 'The Obesity-MASH Burden: What the Numbers Tell Us and How to Screen More Effectively,' Mazen Noureddin, MD, MHSc, FAASLD delves into the following critical questions:

How prevalent is MASH among patients with obesity, and how often do you see this in practice?

What can the broader physician community learn from the scale of this relationship?

Walk us through your current approach to screening for MASH in your patients with obesity: what does that process look like in practice?

Noureddin outlined the striking epidemiological burden of MASLD and MASH in patients with obesity, with prevalence climbing dramatically with increasing BMI, reaching up to 90% in patients with a BMI of 40 or higher, and affecting approximately 60% of individuals with type 2 diabetes. He also drew on his own clinical experience to underscore the urgency of earlier detection, describing patients who first presented to his hepatology practice having already developed decompensated cirrhosis from MASLD or MASH, reinforcing that primary care physicians serve as the critical first line of defense in identifying at-risk patients before the disease reaches this preventable and devastating threshold. Noureddin further outlined his practical multi-step screening approach, beginning with FIB-4 testing in patients with obesity, type 2 diabetes or pre-diabetes, or two or more metabolic risk factors, with scores above 1.3 warranting follow-up and scores above 2.67 requiring prompt hepatology or gastroenterology referral, followed by secondary confirmation with elastography or more specific fibrosis blood tests.

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, 'The Primary Care Gap in MASH: Understanding Screening Barriers and the Path to Better Detection,' features Mazen Noureddin advancing his conversation on obesity and MASH and focusing on the most significant barriers in primary care to screening for MASH in their patients with obesity, and what the field can do to help close that gap.