A nurse practitioner's guide to metabolic dysfunction‑associated steatotic liver disease: From diagnosis to management

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, as demonstrated by a 50% increase in the prevalence over the past three decades. More than one quarter of the global population and nearly 40% of adults in the United States are affected by this burdensome disease. Once thought to be an "innocent bystander," MASLD is now understood as a multisystem disease associated with obesity, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease. Its rising prevalence emphasizes the critical role of primary care providers, including nurse practitioners (NP), in early identification and management. Existing on a spectrum, MASLD ranges from simple hepatic steatosis to nonalcoholic steatohepatitis with inflammation, fibrosis, and cirrhosis. Early stages are often asymptomatic, but progression can lead to portal hypertension, end-stage liver disease, hepatocellular carcinoma, and death. Disease management focuses on lifestyle modification and optimal control of metabolic comorbidities, including glycemic management, statin therapy for dyslipidemia, blood pressure control, and treatment for obstructive sleep apnea. Pharmacologic options remain limited, although vitamin E and pioglitazone may benefit select patients. Furthermore, emerging therapies are under investigation. This article presents a case of MASLD in a patient with metabolic comorbidities and persistently elevated aminotransferases, illustrating the significance of focused assessments and highlighting the role of nurse practitioners in screening, lifestyle counseling, early intervention, and longitudinal follow-up to prevent disease progression and improve outcomes.