MASLD 2025: Detailed Case Based discussion

MASLD 2025: Detailed Case Based discussion by Dr. Om J Lakhani

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MASLD 2025: Detailed Case Based Discussion by Dr. Om J Lakhani

Introduction (0:00-1:45)
Overview of MASLD diagnosis and treatments
Technocranology platform introduction with additional materials
QR code for mobile access to presentation

Case Introduction (1:46-3:20)
Mr. Kumar: 45yo male executive, routine health checkup
No symptoms, previous checkup 5 years ago
Family history: T2DM (mother/brother), father had stroke at 45
Personal: 20g alcohol/day, sedentary, daytime somnolence

Clinical Parameters (3:21-5:00)
BMI: 28.4 (obese by Indian standards)
Waist: 102cm, elevated BP, acanthosis nigricans
Labs: HbA1c 6.2, elevated liver enzymes
Ultrasound: Grade 1 fatty liver
Key insight: "The disease is adiposity" - T2DM and MASLD are consequences

Metabolic Assessment (5:01-8:30)
Patient fits metabolic syndrome criteria
TYG index better than HOMA-IR: log(fasting glucose × triglycerides)
Patient's TYG: 9.59 (insulin resistance cutoff: 4.5)

MASLD Classifications (8:31-12:00)
MASLD: metabolic-associated steatotic liver disease
MASH: metabolic-associated steatohepatitis (formerly NASH)
METALD: metabolic + alcoholic liver disease
Alcohol criteria: MASLD (males: under 30g/day)
"Two-hit concept": Combined factors accelerate progression

Diagnosis Parameters (12:01-15:00)
SGPT cutoff: 35+ in men (patient: 57)
AST/ALT ratio: 2:1+ suggests alcoholic pattern, under 1 suggests MASLD
Diagnosis requires: fatty liver, minimal alcohol, metabolic factors

Imaging Assessment (15:01-21:00)
Ultrasound: good for diagnosis, poor for grading
Fatty liver grades:
Grade 1: Portal vein visible
Grade 2: Portal vein invisible, diaphragm visible
Grade 3: Neither visible
FIB-4 score: patient's 1.64 (intermediate, needs Fibroscan)

Fibroscan Explained (21:01-27:30)
Measures: CAP (steatosis) and LSM/kPa (fibrosis)
CAP values:
Under 238: No steatosis
238-260: Mild
260-290: Moderate
290+: Severe
LSM/kPa values:
2.4-5.5: Normal
5.5-8: F1 fibrosis
8.1-10.8: F2
10.9-14.2: F3
15+: Cirrhosis
Patient: CAP 280 (moderate), F2 fibrosis

MRI Assessment (27:31-30:45)
Emerging techniques:
MRI-PDFF: steatosis
MR elastography: fibrosis
CT1 MRI: steatohepatitis
May replace biopsies for steatohepatitis

Management (30:46-33:20)
F2 fibrosis requires intervention
Options: lifestyle, medications, follow-up
Bariatric surgery for select cases

Lifestyle Measures (33:21-34:05)
Target 7-10% weight loss for steatosis
Physical activity, dietary changes
No safe alcohol level - patient should stop 20g/day

Pharmacological Options (34:06-40:00)
Pharma focus areas: Obesity and MASLD
Treatment categories:
Repurposed T2DM medications
MASLD-specific drugs
CV risk reduction (statins, aspirin)
Vitamin E (800 IU/day) for non-diabetics

Approved Treatments (40:01-47:15)
FDA-approved: Resmetirom (thyroid receptor-β agonist)
Targets intrahepatic hypothyroidism
Shows fibrosis regression
Patent expiring soon
India-approved: Saroglitazar
Dual PPAR-α/γ agonist
EVIDENCES trials support efficacy

Repurposed Antidiabetics (47:16-54:15)
SGLT-2 inhibitors: E-LIFT trial positive
GLP-1 agonists:
Semaglutide: 59% MASH resolution
Tirzepatide: promising results
Pioglitazone: anti-fibrotic effects (diabetics only)

Vitamin E Evidence (54:16-55:10)
PIVENS trial: 800 IU/day benefits non-diabetics
Improves NASH, reduces ALT, steatosis, inflammation

Case Recommendations (55:11-56:35)
For Mr. Kumar (non-diabetic with F2 fibrosis):
7-10% weight loss
Vitamin E 800 IU/day
Saroglitazar
Statin therapy
Consider tirzepatide for weight loss

Conclusion (56:36-57:25)
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