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In this comprehensive CME symposium, Dr. John, Section Chief of GI and Hepatology at the Miami VA and Associate Professor at the University of Miami, breaks down the evolving landscape of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic-associated steatohepatitis (MASH)—formerly known as NAFLD and NASH. Supported by the Chronic Liver Disease Foundation and Global NASH Council, this session delivers expert guidance on screening, staging, and treating MASLD in clinical practice.

Dr. John walks through the 2024 AASLD guidelines, highlighting the use of non-invasive tests (NITs)—including FIB-4, FibroScan, ELF Score, and MR Elastography—to identify fibrosis stage and prioritize patients for treatment without relying on liver biopsies. He explains the importance of fibrosis regression in reducing liver-related mortality and the prognostic role of serial NIT monitoring.

The presentation covers evidence-based strategies for lifestyle modification, including weight loss, diet (Mediterranean, low-carb), intermittent fasting, time-restricted eating, and coffee consumption, and reviews the impact of these interventions on liver stiffness and steatosis.

A key highlight is the clinical use of resmetirom (Rezdiffra), the first FDA-approved treatment for MASH with F2–F3 fibrosis. Dr. John explains its mechanism of action as a THR-β agonist, appropriate patient selection using FibroScan and MRE thresholds, monitoring protocols, and how to manage side effects and statin interactions.

Finally, Dr. John previews emerging therapies in the MASH pipeline, including GLP-1 receptor agonists (semaglutide, tirzepatide), FGF21 analogs, and dual agonists like cotadutide and survodutide, with promising data on fibrosis regression and NASH resolution.