New European recommendations on metabolic steatosis

New recommendations for clinical practice on the management of metabolic steatosis have been issued jointly by 3 European scientific societies bringing together specialists in hepatology (European Association for the Study of the Liver, EASL), diabetes (European Association for the Study of Diabetes, EASD) and obesity (European Association for the Study of Obesity, EASO), and published in June 2024 in the Journal of Hepatology.

See the scientific publication

Hepatologist Prof. Vlad Ratziu (IHU ICAN / AP-HP) contributed his expertise by taking part in the editorial committee for this update of clinical practice guidelines, which also takes stock of knowledge, prevention, screening, assessment and treatment of the disease.

Concepts: steatosis, steatohepatitis, cirrhosis and cancer

Metabolic steatosis (MASLD) is the accumulation of intrahepatic fat (steatosis) in the presence of one or more cardiometabolic risk factors.

The prevalence of this condition is constantly on the rise, affecting between 25% and 40% of individuals, depending on the country. Not everyone will develop a severe form of the disease. The presentation covers a wide spectrum, from benign conditions to much rarer forms that can have serious consequences for health:

  • Isolated steatosis, which usually does not progress,
  • Steatohepatitis (steatosis and inflammation of the liver) (formerly NASH), which can lead to fibrosis,
  • Fibrosis, which builds up progressively and may, in the final stages, develop into cirrhosis,
  • Cirrhosis,
  • And liver cancer (hepatocellular carcinoma).

New European recommendations

Thanks to a rigorous procedure, known as the DELPHI method, and involving over 80 international experts, the new recommendations drawn up by the editorial board representing the three learned societies, EASL, EASD and EASO, offer an update of knowledge based on evidence-based medicine to better prevent and diagnose metabolic steatosis, and avoid severe complications.

In summary, the conclusions include the following key recommendations:

  • Case-finding strategies for steatohepatitis with hepatic fibrosis, using non-invasive tests, should be applied in people with cardiometabolic risk factors (particularly in the presence of type 2 diabetes (T2DM) or overweight), abnormal liver tests or radiological signs of liver steatosis.
  • A progressive approach using blood scores (such as FIB-4) and, sequentially, imaging techniques (such as Fibroscan® elastography) is recommended, to look for advanced fibrosis, which is a predictive factor for liver complications.
  • In adults with metabolic steatosis, lifestyle modification is essential (weight loss, more balanced diet, exercise, cessation of alcohol consumption), coupled with optimal management of comorbidities, including the use of incretin-based therapies for type 2 diabetes, or obesity, if indicated.
  • Bariatric surgery is also an option for people with severe obesity with multiple complications. According to certain criteria, adults with non-cirrhotic steatohepatitis and significant liver fibrosis can be treated with resmetirom, which has demonstrated histological efficacy on inflammation and fibrosis. It was launched in March 2024 in the United States and is expected to be launched in Europe.
  • Unfortunately, no pharmacotherapy is available for patients who have reached cirrhosis, demonstrating the need to prevent the disease from progressing to this advanced stage.

The role of IHU ICAN in the management of MASLD and MASH

Since 2019, IHU ICAN has set up the 1st hospital structure for multi-organ diagnosis and comprehensive care dedicated to metabolic steatohepatitis, located at the heart of Hôpital de la Pitié-Salpêtrièrein Paris.

Directed by Dr Raluca Pais and Prof Vlad Ratziu, the MASH clinic is a unique care pathway designed to improve the diagnosis of this pathology and the management of patients suffering from it.

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