Cirrhosis & NAFLD

Also known as: chronic liver disease · fatty liver · MASH · MASLD · NASH · portal hypertension

Also relevant to Endocrine & Metabolic

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United StatesACG/AGA/AASLD

Current

AASLD Practice Guidance on the Clinical Assessment and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease

AASLD · 2023 · 2023 (with targeted 2024/2025 updates)

AASLD's practice guidance on assessing and managing fatty liver disease, now framed as metabolic dysfunction-associated steatotic liver disease (MASLD), covering risk stratification, non-invasive testing and management including advanced fibrosis and cirrhosis.

The guidance covers patient selection for treatment, management of comorbidities, and monitoring of treatment safety and efficacy. source
AASLD has issued supplementary targeted updates alongside the 2023 document, including a nomenclature update and drug-specific updates. source

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EuropeUEG/EASL

Current

EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)

EASL / EASD / EASO · 2024

A joint European guideline from the liver, diabetes and obesity societies on identifying and managing metabolic dysfunction-associated steatotic liver disease, reflecting the shift away from the NAFLD terminology.

The guideline is issued jointly by EASL, EASD and EASO, reflecting the metabolic comorbidities central to the condition. source
EASL lists it as the current 2024 clinical practice guideline for MASLD. source

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US vs EU key differences

Document type and authorship differ: the European text is a tri-society clinical practice guideline issued jointly by EASL, EASD and EASO, reflecting shared hepatology-diabetes-obesity care, while the US document is single-society AASLD Practice Guidance rather than a formally graded guideline. source
FIB-4 age banding differs: AASLD guidance applies the 1.3 cutoff only from age 36, treats FIB-4 as unreliable at age 35 or younger, and shifts to a 2.0 cutoff from age 65; the EASL algorithm simply uses 1.3 under age 65 and 2.0 at 65 and above. source
Drug currency differs: the 2024 EASL-EASD-EASO guideline already incorporates resmetirom for non-cirrhotic MASH with stage 2 or greater fibrosis, whereas the 2023 AASLD guidance required a separate October 2024 addendum to add it. source
The European guideline gives explicit positioning for metabolic therapies: bariatric surgery is recommended for non-cirrhotic MASLD with obesity, and GLP-1 receptor agonists are endorsed for their diabetes and obesity indications rather than as MASH-targeted drugs. source

What changed recently

EU2016 → 20242024-06-01
This update of the 2016 EASL-EASD-EASO NAFLD guideline redefines the disease as MASLD, requiring hepatic steatosis plus at least one cardiometabolic risk factor and absence of harmful alcohol intake. It formalises non-invasive case-finding for fibrosis in people with type 2 diabetes, obesity or abnormal liver enzymes, and for the first time recommends considering resmetirom for non-cirrhotic MASH with stage 2 or greater fibrosis.
source ↗curation confidence 90%
US2018 → 2023 (with targeted 2024/2025 updates)2023-05-01
The 2023 AASLD guidance adopts the new MASLD/MASH nomenclature agreed by multisociety Delphi consensus in place of NAFLD/NASH, and makes noninvasive tests such as FIB-4 and elastography the primary route for identifying moderate-to-advanced fibrosis rather than liver biopsy. It also expands the use of noninvasive markers for risk prediction and follow-up of treatment response.
source ↗curation confidence 90%

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