Updated Care Pathway for MASLD Risk Stratification : Gastroenterology | Jul 2026

Introduction:

Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as one of the most prevalent chronic liver diseases worldwide, affecting nearly one-third of adults and a majority of individuals with type 2 diabetes. Beyond liver-related complications, MASLD is strongly associated with cardiovascular disease, reduced quality of life, and increased mortality. Recent advances in nomenclature, noninvasive diagnostics, and therapeutic options have necessitated an updated, practical framework for patient management.

Problem Statement:

Despite the growing burden of MASLD, many patients remain undiagnosed or are identified only after developing advanced fibrosis or cirrhosis. Variability in screening practices, limited access to specialist care, and uncertainty regarding risk stratification contribute to delayed diagnosis and suboptimal management. Clinicians require a structured and evidence-based approach that can be applied across primary care and specialty settings.

Summary:

This updated AGA Clinical Care Pathway provides a comprehensive framework for the identification, risk stratification, and management of patients with MASLD and metabolic dysfunction–associated steatohepatitis (MASH). Developed by a multidisciplinary international panel, the pathway incorporates recent advances in disease nomenclature, noninvasive fibrosis assessment, and therapeutic management. The document emphasizes that MASLD should be actively considered in patients with metabolic risk factors, particularly type 2 diabetes, obesity, and cardiometabolic disease. A central focus of the pathway is the early identification of patients at risk for advanced fibrosis using noninvasive tests, allowing efficient triage and reducing unnecessary specialist referrals. The updated recommendations also reinforce the importance of comprehensive cardiometabolic risk management, recognizing cardiovascular disease as the leading cause of mortality in this population. In addition, the pathway integrates evolving evidence regarding pharmacologic therapies, obesity management, and multidisciplinary care models. Practical implementation strategies are provided to facilitate adoption across diverse healthcare settings and improve care coordination among primary care providers, endocrinologists, hepatologists, gastroenterologists, cardiologists, and obesity specialists. Overall, this updated pathway reflects the transition of MASLD from a liver-focused condition to a multisystem metabolic disease requiring coordinated risk-based management. By promoting earlier detection, standardized risk assessment, and targeted intervention, the pathway aims to improve liver-related outcomes while addressing the broader cardiometabolic risks faced by patients with MASLD.