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The spectrum of MASLD includes steatosis, metabolic dysfunction-associated steatohepatitis (MASH, previously NASH), fibrosis, cirrhosis and MASH-related hepatocellular carcinoma (HCC). This joint EASL\u2013EASD\u2013EASO guideline provides an update on definitions, prevention, screening, diagnosis and treatment for MASLD. Case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, should be applied in individuals with cardiometabolic risk factors, abnormal liver enzymes and\/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes or obesity with additional metabolic risk factor(s). A stepwise approach using blood-based scores (such as the fibrosis-4 index [FIB-4]) and, sequentially, imaging techniques (such as transient elastography) is suitable to rule-out\/in advanced fibrosis, which is predictive of liver-related outcomes. In adults with MASLD, lifestyle modification\u2014including weight loss, dietary changes, physical exercise and discouraging alcohol consumption\u2014as well as optimal management of comorbidities\u2014including use of incretin-based therapies (e.g. semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated\u2014is advised. Bariatric surgery is also an option in individuals with MASLD and obesity. If locally approved and dependent on the label, adults with non-cirrhotic MASH and significant liver fibrosis (stage \u22652) should be considered for a MASH-targeted treatment with resmetirom, which demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile. No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.<\/jats:p>","DOI":"10.1007\/s00125-024-06196-3","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T04:01:51Z","timestamp":1718251311000},"page":"2375-2392","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":226,"title":["EASL\u2013EASD\u2013EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD): Executive Summary"],"prefix":"10.1007","volume":"67","author":[{"name":"European Association for the Study of the Liver","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"European Association for the Study of Diabetes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"European Association for the Study of Obesity","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Tacke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Horn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent Wai-Sun","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad","family":"Ratziu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Bugianesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Francque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Zelber-Sagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Valenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Roden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fritz","family":"Schick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannele","family":"Yki-J\u00e4rvinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Gastaldelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Vettor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Fr\u00fchbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Dicker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"issue":"10319","key":"6196_CR1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0140-6736(21)01701-3","volume":"399","author":"TH Karlsen","year":"2022","unstructured":"Karlsen TH, Sheron N, Zelber-Sagi S et al (2022) The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. 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(Affiliations: <sup>1<\/sup>Department of Hepatology and Gastroenterology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Berlin, Germany; <sup>2<\/sup>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; <sup>3<\/sup>Sorbonne Universit\u00e9, Institute of Cardiometabolism and Nutrition, Hospital Piti\u00e9 Salp\u00eatri\u00e8re, Paris, France; <sup>4<\/sup>Department of Medical Sciences, Division of Gastroenterology, University of Turin, Turin, Italy; <sup>5<\/sup>Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; <sup>6<\/sup>School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; <sup>7<\/sup>Department of Gastroenterology Tel-Aviv Medical Center, Tel-Aviv, Israel; <sup>8<\/sup>Department of Pathophysiology and Transplantation, Universit\u00e0 degli Studi di Milano, Milan, Italy; <sup>9<\/sup>Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy; <sup>10<\/sup>Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University and University Hospital, D\u00fcsseldorf, Germany; <sup>11<\/sup>Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University D\u00fcsseldorf, D\u00fcsseldorf, Germany; <sup>12<\/sup>German Center for Diabetes Research (DZD), Partner D\u00fcsseldorf, M\u00fcnchen-Neuherberg, Germany; <sup>13<\/sup>Department of Radiology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany; <sup>14<\/sup>University of Helsinki and Helsinki University Hospital, Department of Medicine, Helsinki, Finland; <sup>15<\/sup>Minerva Foundation Institute for Medical Research, Helsinki, Finland; <sup>16<\/sup>Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy; <sup>17<\/sup>Department of Medicine-DIMED, Universita' degli Studi di Padova, Padua, Italy; <sup>18<\/sup>Department of Endocrinology and Nutrition, Cl\u00ednica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain; <sup>19<\/sup>Internal Medicine D & Obesity Clinic, Hasharon Hospital-Rabin Medical Center. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel)The authors would like to thank the members of the Delphi Panel of this Clinical Practice Guideline for their valuable contribution: Quentin Anstee, Marco Arrese, Heike Bantel, Giulia Besutti, J\u00e9r\u00f4me Boursier, Christopher Byrne, Ali Canbay, Cyrielle Caussy, Helena Cortez-Pinto, Mattias Ekstedt, Mirto Foletto, Jacob George, Liana Gheorghe, Isabel Graupera, Hannes Hagstr\u00f6m, Kate Hallsworth, Onno Holleboom, Achim Kautz, Marko Korenjak, Karoline Lackner, Christos Lionis, Giulio Marchesini, Juris J. Meier, Juan M. Mendive, Luca Miele, Geltrude Mingrone, J. Bernadette Moore, Philip Newsome, George Papatheodoridis, Valerie Paradis, Gianluca Perseghin, Ralph Peterli, Salvatore Petta, Manuel Romero-Gomez, J\u00f6rn M. Schattenberg, Silvia Sookoian, Wendy Spearman, Norbert Stefan, Maja Thiele, Dina Tiniakos, Emmanouil Tsochatzis, Bernard Van Beers, Jos\u00e9 Willemse, Yusuf Yilmaz, and Volkan Yumuk. The authors would also like to thank the external reviewers, and the EASL, EASD and EASO Governing Boards for their valuable contribution to the review process.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"Luca Valenti has disclosed speaking engagements with Viatris, Novo Nordisk, and GSK; consulting roles with Novo Nordisk, Pfizer, Boehringer Ingelheim, Resalis, and MSD; and received unrestricted grant support from Gilead. Elisabetta Bugianesi serves as a consultant for Novo Nordisk, Boehringer Ingelheim, Eli Lilly, Pfizer, Bristol-Myers Squibb, and MSD. Amalia Gastaldelli has acted as a consultant for Boehringer Ingelheim, Eli Lilly and Company, and Metadeq Diagnostics; participated in advisory boards for Boehringer Ingelheim, Merck Sharp & Dohme, Novo Nordisk, Metadeq Diagnostics, and Pfizer; and received speaker's honorarium or other fees from Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, and Pfizer. Frank Tacke\u2019s lab has received research funding from Gilead, AstraZeneca, and MSD (funding to the institution); he has received honoraria for consulting or lectures from AstraZeneca, Gilead, AbbVie, BMS, Boehringer, Intercept, Falk, Inventiva, MSD, GSK, Orphalan, Merz, Pfizer, Alnylam, Novo Nordisk, Sanofi, and Novartis. Michael Roden has participated in consulting for and\/or scientific advisory boards of BMS, Boehringer Ingelheim Pharma, Echosens, Eli Lilly, Madrigal, MSD, Novo Nordisk, as well as in clinical trials supported by Boehringer Ingelheim, Novo Nordisk, and Nutricia\/Danone. Paul Horn received grants from Novo Nordisk (through the University of Birmingham) and MSD (through Charit\u00e9 - Universit\u00e4tsmedizin Berlin); speaking fees from Orphalan; and travel support from IPSEN. Hannele Yki-J\u00e4rvinen declares no conflicts of interest regarding the present work. Shira Zelber-Sagi received travel support for attending a conference and honoraria for a lecture presentation in this conference by AbbVie, a one-time consulting fee by SIEMENS, and holds an unpaid leadership role as Chair-elect of the EASL public health committee. Vincent Wong has served as a consultant or advisory board member for AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions, and Visirna; a speaker for Abbott, AbbVie, Echosens, Gilead Sciences, Novo Nordisk, and Unilab; received a research grant from Gilead Sciences, and is a co-founder of Illuminatio Medical Technology. Gema Fr\u00fchbeck received payment of honoraria for attendance to Advisory Boards from Lilly, and Novo Nordisk as well as payment of honoraria for lectures as Member of the OPEN Spain Initiative. Sven Francque holds a senior clinical investigator fellowship from the Research Foundation Flanders (FWO) and has acted as consultant for Astellas, Falk Pharma, Genfit, Gilead Sciences, GlympsBio, Janssens Pharmaceutica, Inventiva, Merck Sharp & Dome, Pfizer, Roche. He has acted as consultant for Abbvie, Actelion, Aelin Therapeutics, AgomAb, Aligos Therapeutics, Allergan, Alnylam, Astellas, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristoll-Meyers Squibb, CSL Behring, Coherus, Echosens, Dr. Falk Pharma, Eisai, Enyo, Galapagos, Galmed, Genetech, Genfit, Genflow Biosciences, Gilead Sciences, Intercept, Inventiva, Janssens Pharmaceutica, PRO.MED.CS Praha, Julius Clinical, Madrigal, Medimmune, Merck Sharp & Dome, Mursla Bio, NGM Bio, Novartis, Novo Nordisk, Promethera, Roche, Siemens Healthineers, and lectured for for Abbvie, Allergan, Bayer, Eisai, Genfit, Gilead Sciences, Janssens Cilag, Intercept, Inventiva, Merck Sharp & Dome, Novo Nordisk, Promethera, Siemens. Dror Dicker received grants, personal fees, and nonfinancial support from NovoNordisk and Eli Lilly, and personal fees and nonfinancial support from Boehringer Ingelheim outside the submitted work. Vlad Ratziu serves as a consultant for Novo-Nordisk, Madrigal, Boehringer-Ingelheim, GSK, and 89 Bio; and has a grant to institution from MSD. Fritz Schick declares no conflict of interest pertaining to this article. Roberto Vettor has received honoraria from Novo Nordisk, Eli Lilly and AstraZeneca, and has served on advisory boards for Novo Nordisk and Eli Lilly.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"Each panel member was responsible for drafting a specific section of the guidelines. The Panel Chair and Assistant to Chair were then responsible for compiling and extensively revising the full manuscript text, which was subsequently reviewed, revised and approved by all panel members.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}