Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) in People with Diabetes: The Need for Screening and Early Intervention. A Consensus Statement of the American Diabetes Association.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease (NAFLD), is a growing but often unrecognized medical problem for people with diabetes (particularly type 2 diabetes). Liver health has not been at the forefront of complications tracked for disease prevention, as traditionally done for diabetic retinopathy, nephropathy or neuropathy. However, liver steatosis affects about two out of three individuals with type 2 diabetes, especially when associated with obesity, and places them at an increased risk for metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, hepatocellular carcinoma (HCC) and overall liver-related mortality. MASLD is also associated with extrahepatic cancers, atherosclerotic cardiovascular disease, progression from prediabetes to type 2 diabetes and negatively impacts health-related quality of life. However, most individuals and their healthcare professionals remain unaware of the severe hepatic/extrahepatic health risks associated with MASLD and the need for early identification. Recognizing this knowledge gap and the rising prevalence of MASLD, this consensus statement is a call to action to screen for liver fibrosis and risk-stratify people with prediabetes or type 2 diabetes, especially in the presence of obesity. This consensus explains the rationale for the recent MASLD nomenclature change, how to best risk-stratify, current treatment options and long-term monitoring, the value of an interprofessional approach to disease management, and the impact of alcohol intake on liver health. More awareness about the health risks associated with MASLD and broad adoption of screening for liver fibrosis as a new standard of care holds promise for a future without cirrhosis for people with prediabetes and type 2 diabetes.