Treatment of MASLD in Nonalcoholic Steatohepatitis Without Diabetes
This protocol applies to patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in whom the condition has progressed to nonalcoholic steatohepatitis (NASH) in the absence of diabetes mellitus. The lack of diabetes is clinically significant — it shapes which treatment options are relevant and which additional considerations apply.
Clinical scenario: Nonalcoholic steatohepatitis (NASH) without diabetes mellitus. This is a first-line treatment situation. The specific absence of diabetes opens the door to targeted options that are addressed in the full protocol but are not applicable to the general MASLD population.
Treatment Goals
- Weight loss of 3%–5% to improve hepatic steatosis.
- Weight loss exceeding 10% is generally required to achieve meaningful improvement in NASH and hepatic fibrosis.
Treatment Approach (partial summary)
The cornerstone of management is a structured, liver-protective lifestyle intervention — centred on dietary modification designed to achieve a caloric deficit and a meaningful increase in physical activity. The specific dietary quality emphasis, the activity targets, and the additional considerations that are particular to patients without diabetes are detailed in the full protocol.
References
DOI: 10.1097/HEP.0000000000000323
- A healthy diet and regular exercise form the foundation of treatment for the vast majority of those with NAFLD.
- Patients with NAFLD who are overweight or obese should be prescribed a diet that leads to a caloric deficit. When possible, diets with limited carbohydrates and saturated fat and enriched with high fiber and unsaturated fats (e.g., Mediterranean diet) should be encouraged due to their additional cardiovascular benefits.
- Patients with NAFLD should be strongly encouraged to increase their activity level to the extent possible. Individualized prescriptive exercise recommendations may increase sustainability and have benefits independent of weight loss.
- Weight loss of 3%–5% improves steatosis, but greater weight loss (>10%) is generally required to improve NASH and fibrosis.
- Vitamin E can be considered in select individuals as it improves NASH in some patients without diabetes.
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