Coordinating care when managing MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition characterized by an accumulation of excess fat in the liver. It is formerly known as non-alcoholic fatty liver disease (NAFLD) and as that name implies, MASLD is not caused by alcohol consumption. MASLD occurs alongside other disorders that affect metabolism (how the body uses energy), especially the metabolism of fats (where the liver plays an integral role).

MASLD occurs across several disease stages, with advanced stages that cause liver inflammation, scarring (fibrosis), and in severe cases, severe scarring and irreversible damage to the liver (cirrhosis). Treatment can help prevent MASLD from progressing.

Treatment for MASLD

Treatment for MASLD focuses on addressing the underlying metabolic problems that are contributing to excess fat in the liver. All treatment plans will include lifestyle modifications, including diet and exercise. People are advised to follow a heart healthy diet (the Mediterranean diet would be one example), and to increase the amount of time they are physically active. A person should discuss their current fitness level, exercise recommendations, and exercise limitations with a healthcare provider.

Medications may also be a part of a treatment plan. This can include medications needed to manage weight, blood glucose levels, blood pressure, and cholesterol.

There is also a medication approved for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced fibrosis. Formerly known as nonalcoholic steatohepatitis (NASH), MASH is an advanced form of MASLD where there is scarring and damage to the liver.

Following all parts of a treatment plan is essential to getting the best result from treatment. This includes following diet, exercise, and lifestyle recommendations outlined by your healthcare provider, taking all medications as instructed, and attending all follow-up appointments.

Coordinating care for MASLD

While treatment is typically overseen by a hepatologist (a liver specialist) or a gastroenterologist (a specialist in digestive system disorders), a person may work with multiple healthcare providers with different specialties. For example, a primary care provider, endocrinologist, diabetes educator, cardiologist, and registered dietitian may all be members of your healthcare team, depending on your treatment needs

It's important that the different members of your healthcare team are in communication with one another. This is called care coordination. Here are two strategies that can help:

Designate a point person

Communicating with multiple healthcare providers about different aspects of MASLD care can be overwhelming. Consider designating one healthcare provider as your "point person."

This provider should maintain an overview of all aspects of your MASLD care, including diagnosis information, contact details for other providers, and treatment information. Your point person may be a specialist such as a gastroenterologist or hepatologist, or your primary care provider.

Organize a personal health record

Maintaining an organized personal health record helps ensure all providers have access to necessary information. This file should contain:

• Test results including liver function tests and imaging studies
• Evaluations and workups from specialists
• Treatment records, including medications you’ve been prescribed and medical procedures
• Contact information for all of your healthcare providers
• Insurance information
• Copies of bills, receipts, explanation of benefits documents, and other information related to the financial aspects of treatment

Include your own notes from appointments, including questions you’ve asked and information provided by healthcare providers.

Keeping this information organized can save time when communicating with an insurance provider or when you see a new specialist who needs information on previous tests and treatments.

Remember, treatment for MASH is individualized, and a healthcare provider will be your best source of information about your diagnosis and treatment goals. You are also an important source of information for your healthcare team. Be honest if something isn't working. Prepare for your appointments. Take an active role in your care and treatment decisions.