Ep 205 – Metabolic dysfunction-associated steatotic liver disease and hepatitis

Liver disease is often overlooked in primary care, yet it is one of the fastest-growing causes of morbidity and mortality in the UK. Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), now affects around one-third of the UK population, with prevalence rising and all-cause mortality worsening over time. In this second episode of a series on hepatology and hepatitis, Dr James Waldron is joined by Dr Rik Fijten (GP Partner, Hepatitis C GP Champion for Bexley and GP Clinical Fellow in Gastroenterology) to explore why MASLD matters to GPs, why it is so common and why primary care is central to identifying disease early and preventing progression. They discuss why clinicians need to raise this often “silent” disease proactively and how it should be considered alongside diabetes, hypertension and weight management. The conversation covers how to approach abnormal liver function tests, how to assess fibrosis risk using simple non-invasive tools and how MASLD fits into the wider cardio–renal–metabolic model of long-term condition care. The episode also looks ahead to emerging treatments and what the future may hold for patients.

Key take-home points

• MASLD, formerly known as NAFLD, affects around 30% of the UK population, with prevalence increasing and outcomes worsening over time.
• It is usually asymptomatic, meaning GPs need to actively think about it rather than wait for symptoms.
• MASLD should be considered routinely in people with type 2 diabetes, hypertension, obesity and metabolic risk factors.
• Progression to metabolic dysfunction-associated steatohepatitis (MASH) increases the risk of fibrosis, cirrhosis, hepatocellular carcinoma and liver failure.
• It is estimated that around 10–15% of people with MASH develop advanced fibrosis or cirrhosis.
• MASLD is associated with an estimated £2–4 billion annual cost to the NHS when complications are included.
• Cardiovascular (CV) disease is the leading cause of death in people with MASLD, making CV risk management central to care.
• Coding matters to consider overall risk management and treatment.
• Assessment should be holistic and team-based, including HbA1c, lipids, blood pressure and weight, alongside lifestyle support.
• When reviewing abnormal liver function tests, GPs should take a careful history, assess metabolic and alcohol risk and consider blood-borne virus testing where appropriate.
• FIB-4 (using age, aspartate aminotransferase, alanine aminotransferase and platelets) is a simple first-line tool to stratify fibrosis risk and guide further investigation or referral; enhanced liver fibrosis testing may also be used.
• MASLD fits within a broader cardio–renal–metabolic framework, reinforcing the value of integrated care.
• Emerging evidence suggests a future role for treatments such as glucagon-like peptide-1 receptor agonists, with trials showing significant improvement in MASH resolution compared with placebo.
• The key message for primary care: MASLD is common, often reversible and something we need to bring into the consultation ourselves.

Helpful resources

1. NHS. 2025. https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/.
2. NICE. 2016. https://www.nice.org.uk/guidance/ng49.
3. British Liver Trust. https://britishlivertrust.org.uk/.
4. EASL. https://easl.eu/.
5. EASL, EASD, EASO. Obes Facts. 2024;17(4):374-444. doi: 10.1159/000539371.

Disclaimer

This content is for medical education purposes only and does not constitute clinical advice. While specific drugs and dosages may be discussed, clinicians should always refer to local protocols and official prescribing information before administering medication.