Treatment of MASLD in Normal-Weight Patients (BMI <25 kg/m²)

Metabolic dysfunction-associated steatotic liver disease (MASLD) can occur in individuals who are not overweight or obese. This protocol addresses the specific management of MASLD confirmed in a patient with a normal body weight.

Clinical Scenario

This protocol applies to adults with confirmed MASLD who have a body mass index below 25 kg/m² (non-Asian ethnicity) or below 23 kg/m² (Asian ethnicity) — a presentation referred to as normal-weight MASLD.

Treatment Goals

3–5% weight reduction
Reduction of liver fat

Approach

For normal-weight adults with MASLD, the protocol recommends targeted lifestyle interventions — dietary modification and structured physical activity — directed at reducing hepatic fat. The full stepwise recommendations, specific targets, and decision points are detailed in the complete protocol.

Full regimen details available via the link below →

Instant Access to Structured Evidence-Based Regimens

References

Normal-weight MASLD is defined as the presence of MASLD in an individual with a BMI <25 kg/m² (non-Asian ethnicity) or <23 kg/m² (Asian ethnicity).

In normal-weight adults with MASLD, diet and exercise interventions should be recommended to reduce liver fat (LoE 3, strong recommendation, strong consensus).

In an RCT of a 12-month lifestyle intervention programme, a 3–5% weight reduction led to remission of MASLD (measured by 1H-MRS) among 50% of the individuals without obesity.

DOI: 10.1016/j.jhep.2024.04.031 View source ↗