MASLD – Tips for Community Health Workers

March 12, 2024
Anandalakshmi Ponnaluri, MBBS

In February we learned about MASLD and its terminology and symptoms, MASLD-1 (Metabolic Dysfunction-Associated Steatotic Liver Disease. This article highlights the screening, diagnosis, and prevention of the MASLD.

How can we tell if someone is at high risk for MASLD and needs screening?

Look for signs like obesity (BMI>35) or excess fat around the waist, unusual fat patterns, signs of insulin resistance (like fat pad on the upper back, dark patches on the skin), and signs of advanced liver disease (such as swollen veins in the belly or redness in the palms of the hands). These signs indicate a higher risk of MASLD.

Who should be screened for MASLD according to recent guidelines?

People at higher risk for MASLD should be screened. This includes those with prediabetes or type 2 diabetes (T2DM), obesity and two or more heart and metabolic risk factors, people whose imaging shows fat buildup in the liver by chance, individuals with high liver enzyme levels, and those with a family history of cirrhosis.

What tests are recommended for screening MASLD?

 Liver enzyme tests aren't enough. If ALT levels are high, it might mean liver issues but not always MASLD. Further tests are needed to see if ALT levels stay high. Ultrasound is recommended but might not detect MASLD well in obese patients or those with other liver problems. The Fibrosis-4 Index (FIB-4) is a single test doctors use to screen for MASLD.

How does the Fibrosis-4 Index (FIB-4) work in screening for MASLD?

 The FIB-4 Index uses age, AST, ALT, and platelet count to predict liver fibrosis. Scores are categorized as low risk, indeterminate, or high risk. Low-risk patients can be managed by regular doctors, while high-risk patients should see liver specialists. High-risk patients need FIB-4 screening every 1-2 years.

What additional testing is recommended for patients with indeterminate FIB-4 scores?

 Patients with uncertain FIB-4 scores should get more tests to better understand their risk. They might have the Enhanced Liver Fibrosis (ELF) Test or liver stiffness measured with elastography.

Is liver biopsy necessary for diagnosis?

 A liver biopsy is the best way to diagnose MASLD. It's considered if non-invasive tests don't give clear results or if there's a suspicion of other liver problems. But it's expensive and invasive, so specialists usually do it.

Can patients with MASLD drink alcohol?

 Patients with MASLD, especially those with serious liver problems, should avoid alcohol. Drinking too much can make liver damage worse and lead to a condition called Metabolic Associated with Alcohol Liver Disease. Guidelines suggest women should have no more than 20g of alcohol per day (140-350g/week) and men no more than 30g (210-420g/week). 

What are the recommendations for vaccinations in patients with MASLD?

Patients with MASLD should make sure they have all their vaccinations up-to-date. This includes vaccines for hepatitis A, hepatitis B, pneumococcal polysaccharide (PPSV23), flu, tetanus-diphtheria-pertussis (Tdap), shingles (zoster), human papillomavirus (HPV), measles-mumps-rubella (MMR), chickenpox (varicella), and COVID-19. These vaccines help protect the liver and overall health by preventing infections.

What should community healthcare workers know about medications and supplements for patients with MASLD?

Some medications like methotrexate, tamoxifen, and amiodarone can harm the liver and should be avoided in patients with significant liver damage. Additionally, over-the-counter medications and herbal supplements can also be harmful to the liver as they are not regulated. It's important to be cautious and avoid known hepatotoxic agents and supplements.

What pain management options are recommended for patients with cirrhosis?

 Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with cirrhosis as they can cause bleeding and kidney problems. Instead, acetaminophen is the preferred pain reliever. However, doses should be kept under 2 grams per day to avoid liver damage.

How can community healthcare workers ensure the liver health of patients with MASLD?

By understanding the risks associated with medications, supplements, and pain management options, community healthcare workers can better protect the liver health of patients with MASLD. They should be mindful of avoiding liver-harming medications and encouraging safe pain management practices.

In conclusion, MASLD is a growing concern and could soon become the leading cause of liver transplants. It often goes unnoticed due to its silent progression. Early intervention is crucial, and tools like the FIB-4 score help identify patients who need attention. While pharmacotherapy options are expanding, lifestyle changes and managing related health issues remain vital. Community health workers and Primary care physicians play a key role in recognizing, treating, and preventing MASLD from progressing further.

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