Abstract:
Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), including metabolic dysfunction-associated steatohepatitis (MASH), are tightly linked disorders that should be approached as part of a unified cardiometabolic disease spectrum rather than as isolated hepatic conditions. MASLD a?ects about 30.0% of the global population, with especially high prevalence in regions heavily burdened by obesity and type 2 diabetes, underscoring its major public health relevance.
This presentation will examine how obesity drives ectopic fat deposition, insulin resistance, chronic inflammation, lipotoxicity, atherogenic dyslipidemia, endothelial dysfunction, and multi-organ injury across the cardio-reno-hepato-metabolic axis. The talk will highlight that MASLD is a systemic disease associated not only with progressive liver fibrosis and cirrhosis, but also with type 2 diabetes, cardiovascular disease, chronic kidney disease, sarcopenia, sleep apnea, and several malignancies. Cardiovascular disease remains the leading cause of death in patients with MASH, reinforcing the need to integrate liver risk into broader obesity and cardiometabolic care pathways.
A major focus will be practical risk stratification in patients with obesity, prediabetes, and type 2 diabetes, including use of FIB-4 and second-line noninvasive testing such as elastography or ELF testing to identify clinically significant fibrosis. The presentation will also review key limitations of FIB-4, particularly in people with obesity and type 2 diabetes, where clinically important fibrosis may be missed if clinicians rely on a single test alone. Evidence-based algorithms from endocrine practice will be discussed to support earlier detection, multidisciplinary referral, and cirrhosis prevention.
Finally, the session will address treatment implications, including the dose-dependent hepatic benefits of weight loss, lifestyle intervention, and the emerging role of incretin-based and other metabolic therapies in MASH management. Clinical data supporting semaglutide, tirzepatide, survodutide, and other liver-relevant obesity therapies will be placed in the context of improving both hepatic and cardiometabolic outcomes. This session will highlight how clinicians caring for people with obesity across endocrinology, hepatology, primary care, cardiology, and obesity medicine can implement integrated management strategies that reduce both major adverse liver outcomes and major adverse cardiovascular events in patients with obesity and MASH.
