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  • Perspective
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Envisioning how to advance the MASH field

Nature Reviews Gastroenterology & Hepatology volume 21, pages 726–738 (2024)Cite this article

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Abstract

Since 1980, the cumulative effort of scientists and health-care stakeholders has advanced the prerequisites to address metabolic dysfunction-associated steatotic liver disease (MASLD), a prevalent chronic non-communicable liver disease. This effort has led to, among others, the approval of the first drug specific for metabolic dysfunction-associated steatohepatitis (MASH; formerly known as nonalcoholic steatohepatitis). Despite substantial progress, MASLD is still a leading cause of advanced chronic liver disease, including primary liver cancer. This Perspective contextualizes the nomenclature change from nonalcoholic fatty liver disease to MASLD and proposes important considerations to accelerate further progress in the field, optimize patient-centric multidisciplinary care pathways, advance pharmacological, behavioural and diagnostic research, and address health disparities. Key regulatory and other steps necessary to optimize the approval and access to upcoming additional pharmacological therapeutic agents for MASH are also outlined. We conclude by calling for increased education and awareness, enhanced health system preparedness, and concerted action by policy-makers to further the public health and policy agenda to achieve at least parity with other non-communicable diseases and to aid in growing the community of practice to reduce the human and economic burden and end the public health threat of MASLD and MASH by 2030.

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Fig. 1: Timeline for the MASLD field.
Fig. 2: MASLD pathophysiology.

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Acknowledgements

J.V.L. acknowledges support to ISGlobal from grant CEX2018-000806-S, funded by MCIN/AEI/10.13039/501100011033, and the ‘Generalitat de Catalunya’, through the CERCA Programme, outside of the submitted work. The authors would like to thank Paul N. Brennan, Dana Ivancovsky Wajcman, Christopher J. Kopka and Marcela Villota-Rivas for their feedback on the manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Alina M. Allen

  2. Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA

    Zobair M. Younossi

  3. The Global NASH Council, Washington DC, USA

    Zobair M. Younossi & Jeffrey V. Lazarus

  4. Duke University, Durham, NC, USA

    Anna Mae Diehl

  5. Center for Liver Diseases, Department of Medicine, The University of Chicago, Chicago, IL, USA

    Michael R. Charlton

  6. CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA

    Jeffrey V. Lazarus

  7. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain

    Jeffrey V. Lazarus

  8. Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Jeffrey V. Lazarus

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  1. Alina M. Allen
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  2. Zobair M. Younossi
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Contributions

All authors researched data for the article. J.V.L. and A.M.A. contributed substantially to discussion of the content and developed the outline. All authors wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Jeffrey V. Lazarus.

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Competing interests

A.M.A. acknowledges grant support to her institution from the National Institutes of Health (DK128127), Novo Nordisk, Pfizer and Target Pharma and advisory board participation for Boehringer Ingelheim and Novo Nordisk outside of the submitted work. Z.M.Y. acknowledges consulting fees from Abbott, AstraZeneca, BMS, Boehringer Ingelheim, Cymabay, Gilead, GSK, Intercept, Madrigal, Merck, Novo Nordisk and Siemens outside of the submitted work. A.M.D. acknowledges grant support to her institution from Boehringer Ingelheim, GSK, Hanmi, Intercept, Inventiva, Madrigal, Novo Nordisk, Tune Therapeutics, and Viking and consulting for Boehringer Ingelheim outside of the submitted work. M.R.C. acknowledges consulting for Bristol-Myers-Squibb, Celgene, Histoindex, Intercept, Madrigal, NGM, Novo Nordisk, Pfizer, Terns, and Theratechnologies and research grants from Gilead Sciences outside of the submitted work. J.V.L. acknowledges grants and speaker fees from AbbVie, Gilead Sciences, MSD, Novo Nordisk and Roche Diagnostics to his institution, grants from Boehringer Ingelheim, GSK and Madrigal to his institution, speaker fees from Echosens, Janssen, Novo Nordisk and ViiV, and consulting fees from Echosens, Gilead Sciences, GSK, Novavax and Roche Diagnostics outside of the submitted work.

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Allen, A.M., Younossi, Z.M., Diehl, A.M. et al. Envisioning how to advance the MASH field. Nat Rev Gastroenterol Hepatol 21, 726–738 (2024). https://doi.org/10.1038/s41575-024-00938-9

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