GNC/GLC Meeting at ALEH 2026 — Mexico City

The Global NASH/MASH Council (GNC) and Global Liver Council (GLC) meeting, held in conjunction with ALEH 2026 in Mexico City, Mexico, brought together leading hepatology experts from Latin America and the global GNC/GLC network. The session was moderated by Professors Mário Pessoa, Marco Arrese, and Zobair Younossi and opened with an update by Dr. Younossi on GNC/GLC activities, including dozens of ongoing global research initiatives and the tremendous academic productivity of the GNC/GLC collaborative network. The scientific program focused on the growing burden of metabolic dysfunction-associated steatotic liver disease (MASLD) and steatotic liver disease (SLD) in Latin America. Dr. Francisco Idalsoaga reviewed the epidemiology of MASLD across the region, while Dr Luis Díaz Piga highlighted the importance of generating high-quality prospective Latin American SLD registry data. Professor Cristiane Villela addressed access to emerging MASLD therapies in Latin America, emphasizing regional challenges and opportunities as effective pharmacologic treatments become increasingly available. The final portion of the meeting focused on strengthening Latin American participation and leadership within the GNC/GLC global research network. Professor Marco Arrese presented perspectives on expanding regional contributions to ongoing and future GNC/GLC projects, followed by an interactive discussion moderated by Professors Pessoa and Younossi. The discussion emphasized opportunities to enhance prospective data collection, expand multinational collaborations, increase the representation of Latin American populations in global studies, and develop research initiatives addressing priorities specific to the region. The GNC/GLC remains committed to expanding meaningful global and regional collaboration, advancing high-quality research, promoting patient-centered care, and supporting policies that improve the awareness, diagnosis, and treatment of liver disease. The ALEH 2026 meeting further strengthened the partnership between the GNC/GLC and the Latin American hepatology community and reinforced our shared commitment to improving liver health outcomes throughout Latin America and worldwide.

Transforming the Future of Hepatology

Pleased to share our new publication, “Hepatology: Emerging Paradigms in MASLD, Viral Hepatitis, Cholestatic Liver Disease, Portal Hypertension and Hepatocellular Carcinoma” in Liver International, summarizing key advances presented at the First Annual Paris International Liver Meeting (PILM) 2026. The review highlights a fundamental shift in hepatology—from managing advanced disease and its complications toward earlier identification, risk stratification, and disease modification. Across MASLD/MASH, viral hepatitis, cholestatic liver disease, portal hypertension, and HCC, advances in non-invasive testing, targeted therapies, and precision medicine are rapidly transforming clinical care. Collectively, these developments point toward a new era of hepatology centered on earlier intervention and individualized, mechanism-driven treatment. Members of the Global NASH/MASH Council (GNC) and Global Liver Council (GLC) were delighted to support this important international meeting and the collaborative publication that followed. We are grateful to all our colleagues whose expertise and contributions made PILM 2026 and this publication possible.  

The dynamic spectrum of steatotic liver disease: the global perspective liver disease: the global perspective

One Spectrum, Not Three Silos: Rethinking Steatotic Liver Disease New review from the Global NASH/MASH Council (GNC) published in Nature Reviews Gastroenterology & Hepatology We are pleased to announce the publication of "The dynamic spectrum of steatotic liver disease: the global perspective" in Nature Reviews Gastroenterology & Hepatology. Led by Dr. Zobair M. Younossi and developed with an international group of authors from the GNC spanning six continents, this review offers a new perspective on the way steatotic liver disease (SLD) is currently classified and managed. Rather than treating MASLD, MetALD and ALD as distinct, mutually exclusive diagnostic categories, SLD should be considered a single dynamic spectrum. The evidence is compelling: cardiometabolic risk factors are present across all SLD subtypes, required by definition in MASLD and MetALD and found in roughly 98% of individuals with ALD. Alcohol intake, meanwhile, is routinely under-reported, with objective biomarker studies suggesting that 10 to 40% of people initially classified as having MASLD would be reclassified as MetALD or ALD over time. The implications reach across clinical practice, research and policy. The review calls for routine, repeated assessment of alcohol intake, cardiometabolic risk and fibrosis in clinical practice, combining structured screening tools such as AUDIT-C with objective biomarkers like phosphatidylethanol and non-invasive fibrosis tests. It also highlights a critical gap in drug development: late-phase MASH trials have systematically excluded patients with significant alcohol use, despite the frequent real-world overlap between metabolic and alcohol-related liver injury, leaving the patients who may need treatment most outside the evidence base. Patient-centred care that matches this reality will require genuinely multidisciplinary models spanning hepatology, primary care, endocrinology, addiction medicine and nutrition, alongside public health measures to address the compounded risks of alcohol and obesity. Please follow this link to view this publications: https://doi.org/10.1038/s41575-026-01235-3  

GNC and GLC Present 21 Abstracts at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2026

The Global NASH/MASH Council (GNC) and the Global Liver Council (GLC) are pleased to announce that 21 abstracts from our collaborative research programs have been accepted for presentation at The Liver Meeting 2026, the annual meeting of the American Association for the Study of Liver Diseases (AASLD), taking place this November in Denver, Colorado. The accepted work includes: 4 Oral Presentations 4 Posters of Distinction 13 Posters Together these studies span the epidemiology, diagnosis, treatment, patient-reported outcomes, and economic burden of steatotic liver disease, viral hepatitis, and liver transplantation across global populations. What unites this body of work is its scale and its reach. The GNC and GLC were established on the conviction that liver disease is a global problem that cannot be understood, much less solved, from any single country or health system. The abstracts presented here reflect that conviction in practice: multinational surveys of clinical practice spanning dozens of countries across six continents, pooled registry and cohort analyses linking data from North America, Europe, Latin America, the Middle East, Africa, and the Asia-Pacific region, and global genetic and biomarker studies made possible only by investigators willing to contribute data and expertise to a shared effort. These collaborations bring together hepatologists, epidemiologists, methodologists, health economists, and patient-outcomes researchers from academic centers, public health institutions, and clinical practices worldwide. By pairing that breadth with consistent methodology, our councils are able to produce evidence that is genuinely generalizable, that captures the disparities and regional differences too often lost in single-country studies, and that can inform policy and clinical guidance in the very settings where the burden of liver disease is growing fastest. We congratulate and thank all of our collaborating members, and partners around the world, whose sustained commitment made this collective achievement possible. Accepted Abstracts 1. Sex-Specific Epidemiology and Outcomes in Chronic Liver Disease: A 20-Year US Registry Analysis of Liver Transplant Candidates and Recipients Authors: Linda Henry1, Maria Stepanova1, Giacomo Germani1,2, Adrian Gadano1,3, Patrizia Burra1,2, Rohit Satoskar1,4, Khalid M. AlNaamani1,5, Saleh A. Alqahtani1,6,7, Zobair M. Younossi1,8,9 Type of Presentation: Oral Presentation 2. Sequential Algorithms Using FIB-4, Followed by VCTE or ELF to Detect Advanced Fibrosis: Validation of Risk Stratification Strategy in the United States (U.S.) Primary Care Setting Authors: Zobair M. Younossi MD1,2, James M. Paik PhD1,2, Leyla de Avila BS1, Maria Stepanova PhD1, Markos Kalligeros MD1, 3, Annette Paik1, Khalid M. Al Naamani MD1,4, Saleh AlQahtani MD1,5, Linda Henry PhD1,6 Type of Presentation: Oral Presentation 3. Beyond Alcohol Self-Report: Phosphatidylethanol (PEth) Assessment Uncovers Clinically Significant Alcohol Exposure in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Authors: Zobair M. Younossi¹˒² *, Nikolaj Torp¹˒³ *, Fatema Nader¹, Mads Israelsen¹˒³, Camilla Dalby Hansen³, Markos Kelligerous¹˒⁴, Johanne Kragh Hansen¹, Linda Henry¹˒⁶, Helle Schnefeld¹, Andrei Racila¹˒⁵, Katrine Tholstrup Bech¹, Shira Zelber-Sagi¹˒⁵, Marianne Lerbaek Bergmann¹,7, Maria Stepanova¹˒⁶ ⁺, Aleksander Krag¹˒³ ⁺ Type of Presentation: Oral Presentation 4. Metabolic Dysfunction-Associated Steatohepatitis (MASH) Outpacing Alcohol-Associated Liver Disease (ALD) as the Principal Driver of Rising Steatotic Liver Disease-Associated Liver Cancer Authors: Eliabe S. Abreu 1,2 , James M. Paik 1,3 , Manal Abdelmalek 1,2 , Robert Wong 1,4 , Khalid M. Al Naamani 1,5 ,Saleh Alqahtani 1,6 , Zobair M. Younossi 1,3,7 Type of Presentation: Oral Presentation 5. Reallocating Sedentary Time to Sleep Is Associated With Improved Disease Severity in MASLD Authors: Lynn H. Gerber1*, James M. Paik1,2*, Markos Kalligeros 1, Shelley E Keating 1, 3, Ali A. Weinstein, 1, 4, Jonathan G Stine 5, Shira Zelber-Sagi1, Saleh Alqahtani1,6,7, Kate Hallsworth, 1,8, Elizabeth J. Pekas 1, Zobair M. Younoss1,2 Type of Presentation: Poster of Distinction 6. Development and Validation of a Symptom-Based Patient-Reported Outcome Measure for MASH: The CLDQ-MASH Symptom Questionnaire (CLDQ-MASH-SQ) Authors: Zobair. M Younossi 1,2, Maria Stepanova 1, Issah Younossi 2, Andrei Racila 1 Type of Presentation: Poster of Distinction 7. Genetic polymorphisms associated with metabolic dysfunction–associated steatotic liver disease (MASLD) and adverse clinical outcomes: a global study Authors: Zobair M. Younossi¹˒², Leyla de Avila BS¹˒², Khalid N. AlNaamani¹˒³, Cristiane Villela-Nogueira¹˒⁴, Luca Valenti¹˒⁵, Phunchai Charatcharoenwitthaya¹˒⁶, Javier Crespo¹˒⁷, Silvia Sookoian¹˒⁸, Vincent Wai-Sun Wong¹˒⁹, Atsushi Nakajima¹˒¹⁰, Yusuf Yilmaz¹˒¹¹, Claudia de Oliveira¹˒¹², Mario G. Pessoa¹˒¹², Anna Fracanzani¹˒¹³, Rosa Lombardi¹˒¹³, Wah Kheong Chan¹˒¹⁴, Adriaan G. Holleboom¹˒¹⁵, Jian-Gao Fan¹˒¹⁶, Andrea Siciliano⁵, Giulia Periti⁵, Francesco Malvestiti⁵, Watcharin Wichapolchaiyakul⁶, Paula Izrubieta⁷, Carlos J. Pirola⁸, Takashi Kobayashi¹⁰, Shamsul Mohd Zain17, Kirsi van Eekhout¹⁵, Rui-Xu Yang¹⁶, J. Michael Estep¹, Brian Lam PA¹, Andrei Racila¹, Saleh A. Alqahtani 1, 18, Maria Stepanova PhD¹˒19, on behalf of the Global NASH/MASH Council (GNC) Type of Presentation: Poster of Distinction 8. Liver Transplantation for Alcohol-Related Hepatitis Versus Alcohol-Related Cirrhosis in the United States from 2000–2025: Disease Severity and Clinical Outcomes Authors: Maria Stepanova1, Giacomo Germani1,2, Adrian Gadano1,3, Patrizia Burra1,2, Rohit Satoskar1,4, Linda Henry1, Saleh A. Alqahtani1,5,6, Zobair M. Younossi1,7,8 Type of Presentation: Poster of Distinction 9. Impact of Resmetirom on Health-Related Quality of Life, Work Productivity, and Disease-Specific Symptoms in Compensated MASH Cirrhosis Authors: Zobair M. Younossi1, Fatema Nader1, Becky Taub3, Andrei Racila1,3, Maria Stepanova1,3 Type of Presentation: Poster 10. The Development Divide: How Food Systems Drive Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Through Different Structural Pathways Across 204 Countries Authors: James M. Paik1, 2, Markos Kalligeros1, 3, Shira Zelber-Sagi1, 4, Annette Paik1, Saleh A. Alqahtani 1, 5, Zobair M. Younossi1, 2, 6 Type of Presentation: Poster 11. Factors affecting the management of immunotolerant chronic HBV patients: Results from a worldwide survey of clinical practice Authors: George Papatheodoridis1,2, Maria Buti1,3, Margarita Papatheodoridi, Phunchai Charatcharoenwitthaya1,4, Ajeet Bhadoria1,5, Jian-Gao Fan1,6, Brian Pearlman1,7, Cristiane Villela-Nogueira1,28, Shivaram Prasad Singh1,9, Satoru Kakizaki1,10, Wah-Kheong Chan1,11, Anand Kulkarni1,12, Ashwani K. Singal1,13, Ana Ostojić1,14, Javier Crespo1,15, Christian Tzeuton1,16, Jimmy Che-To Lai1,17, Loreta Kondili1,18, Munkhbat Batmunkh1,19, Munkhjargal Ayurzana1,20, Ming-Lung Yu1,21, George Boon Bee Goh1,22, Dimitrios S. Karagiannakis1,23, Ellina Lytvyak1,24, Amit Goel1,25, Al Naamani Khalid1,26, C Wendy Spearman1,27, Ira Jacobson1,28, Tatyana Kushner1,29,Davaadorj Duger1,20, Yuichiro Eguchi1,30, Mohamed El-Kassas1,31, Sarantuya Gidaagaya1,20, Stuart C Gordon1,32, Saira Khaderi1,33, Pietro Lampertico1,34, Mei‑Ηsuan Lee1,35, Bira Namdag1,20, Ponsiano Ocama1,36, Mario Pessoa1,37, Nikolaos T. Pyrsopoulos1,28, Francesco Paolo Russo1,38, Yusuf Yilmaz1,39,Linda Henry1, Fatema Nader1, Andrei Racila Jr1, Maria Stepanova1, Janus Ong1,40, Zobair Younossi1,41,42 Type of Presentation: Poster 12. Practice patterns and determinants of hepatocellular carcinoma (HCC) surveillance in patients with chronic hepatitis B virus (HBV) infection: Results from a worldwide survey of clinical practice Authors: George Papatheodoridis1,2, Maria Buti1,3, Margarita Papatheodoridi, Phunchai Charatcharoenwitthaya1,4, Ajeet Bhadoria1,5, Jian-Gao Fan1,6, Brian Pearlman1,7, Cristiane Villela-Nogueira1,28, Shivaram Prasad Singh1,9, Satoru Kakizaki1,10, Wah-Kheong Chan1,11, Anand Kulkarni1,12, Ashwani K. Singal1,13, Ana Ostojić1,14, Javier Crespo1,15, Christian Tzeuton1,16, Jimmy Che-To Lai1,17, Loreta Kondili1,18, Munkhbat Batmunkh1,19, Munkhjargal Ayurzana1,20, Ming-Lung Yu1,21, George Boon Bee Goh1,22, Dimitrios S. Karagiannakis1,23, Ellina Lytvyak1,24, Amit Goel1,25, Al Naamani Khalid1,26, C Wendy Spearman1,27, Ira Jacobson1,28, Tatyana Kushner1,29,Davaadorj Duger1,20, Yuichiro Eguchi1,30, Mohamed El-Kassas1,31, Sarantuya Gidaagaya1,20, Stuart C Gordon1,32, Saira Khaderi1,33, Pietro Lampertico1,34, Mei‑Ηsuan Lee1,35, Bira Namdag1,20, Ponsiano Ocama1,36, Mario Pessoa1,37, Nikolaos T. Pyrsopoulos1,28, Francesco Paolo Russo1,38, Yusuf Yilmaz1,39,Linda Henry1, Fatema Nader1, Andrei Racila Jr1, Maria Stepanova1, Janus Ong1,40, Zobair Younossi1,41,42 Type of Presentation: Poster 13. Cost-Effectiveness of Sequential Non-Invasive Testing (NIT) for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) Risk Stratification in US Primary Care: A Lifetime Markov Analysis Authors: Zobair M. Younossi1,2, Khalid AlNaamani¹˒³, Cristiane Villela-Nogueira¹˒⁴, Fatema Nader1, Saleh A. Alqahtani 1,5, Laurent Castera1,6,*,James M. Paik1,2,7,* Type of Presentation: Poster 14. Metabolic Dysfunction-Associated Steatohepatitis (MASH) in Type 2 Diabetes (T2D) Across Nine Countries: Economic Burden and Real-World Implementation Impact (2025–2045) Authors: Zobair M. Younossi1,2, Frank Tacke1,3, Patrizia Burra1,4, Cristiane A. Villela-Nogueira1,5, Javier Crespo1,6, Elisabetta Bugianesi1,7, Hirokazu Takahashi1,8, Yuichiro Eguchi1,9, Mário Guimarães Pessoa1,10, Claudia Pinto Oliveira1,10, Michael Roden1,11, Cyrielle Caussy1,12, Amalia Gastaldelli13, Fernando Bril1,14, Jeremy W. Tomlinson1,15, Paul N. Brennan1,16, Manuel Romero-Gomez1,17, Takumi Kawaguchi1,18, Jerome Boursier1,19, Faisal Abaalkhail1,20, Ahmed Al-Jedai21, Hussain Abdulrahman Al-Omar1,22, Maria Stepanova1, Fatema Nader1, Markos Kalligeros1,23, Laurent Castera1,24, Saleh A. Alqahtani1,25*, James M. Paik1,2,26* Type of Presentation: Poster 15. Two-Decade Trends and Outcomes of Liver Transplantation for Autoimmune Hepatitis in the United States and Europe Authors: Maria Stepanova1, Giacomo Germani1,2, Ana Lleo1,3, Vincent Karam4, Rene Adam5, Saleh A. Alqahtani1,6,7, Linda Henry1,2,8, Patrizia Burra1,2, Zobair M. Younossi1,8,9 Type of Presentation: Poster 16. Liver Transplantation for Steatotic Liver Disease in the United States: Trends and Outcomes from 2000–2025 Authors: Zobair M. Younossi1,2 , Giacomo Germani1,3, Adrian Gadano1,4, Patrizia Burra1,3, Linda Henry1, Khalid M. AlNaamnai1,5, Saleh A. Alqahtani1,6,7, Maria Stepanova1 Type of Presentation: Poster 17. Steatotic Liver Disease (SLD) Subtypes Among Adolescents in the United States: A Nationally Representative Study Authors: Zobair M. Younossi1,2, Annette Paik1, Fatema Nader1,3, Andrei Racila1,3, James M. Paik1,2 Type of Presentation: Poster 18. Racial and Ethnic Disparities in Steatotic Liver Disease (SLD) Subtypes Using a Novel Alcohol-Corrected Classification Authors: Zobair M. Younoss1,2, Markos Kalligeros1, 3, Annett Paik1, Khalid Al Naamani1,4, Waleed Alhazzani1,5, Shadan AlMuhaidib1,5, Basmah Khoja1,6, Saleh AlQahtani1,6, James M. Paik1,2,7 Type of Presentation: Poster 19. Treatment with Resmetirom Improves Symptom Burden in Metabolic Dysfunction-Associated Steatohepatitis Authors: Zobair M. Younossi1, Fatema Nader1, Becky Taub3, Andrei Racila1,3, Maria Stepanova1,3 Type of Presentation: Poster 20. Health-related quality of life in MASLD/MASH treated with essential phospholipids shows improvement in fatigue and activity: CLDQ-MASH results from the EXCEL randomized trial Authors: Zobair M.Younossi, MD; Maria Stepanova, PhD; Katarzyna Wielgus; Branko khalid Popovic Type of Presentation: Poster 21. Faster national development amplifies MASLD but not viral hepatitis or alcohol-associated liver disease Authors: James M. Paik1,2, Eliabe S. Abreu1,3, Annette Paik1, Khalid Al Naamani1,4, Mohamed El-Kassas1,5, Cristiane Villela-Nogueira1,6˒, Saleh AlQahtani1,7, Zobair M. Younossi1,2,8 Type of Presentation: Poster

The Global NASH/MASH Council and Global Liver Council Meeting at EASL 2026, Barcelona, Spain

The biannual meeting of the Global NASH/MASH Council (GNC) and the Global Liver Council (GLC), held in conjunction with EASL 2026 in Barcelona, Spain, convened over 60 leading hepatology experts from across the globe. The meeting was opened by Professor Zobair Younossi, Chair of the GNC/GLC, and was followed by a scientific program featuring distinguished lectures by Professors Emmanuel A. Tsochatzis, Laurent Castera, Naim Alkhouri, Manal Abdelmalek, and Shira Zelber-Sagi. Their presentations highlighted the latest evidence on metabolic dysfunction-associated steatotic liver disease (MASLD), with particular emphasis on risk stratification algorithm implementation and therapeutic strategies, encompassing both pharmacological interventions and lifestyle modifications, for patients with metabolic dysfunction-associated steatohepatitis (MASH). The second half of the meeting was devoted to a comprehensive review of GNC/GLC activities, presented by Professors George Papatheodoridis, Shira Zelber-Sagi, and Zobair Younossi, and included an in-depth presentation on the ultra-processed food project by Dr. Dana Ivancovsky Wajcman. Nearly 50 active global projects spanning steatotic liver disease (SLD), viral hepatitis, hepatocellular carcinoma (HCC), and liver transplantation were reviewed. Throughout the proceedings, lively discussions and constructive debates addressed the most pressing challenges in MASLD and SLD, fostering interdisciplinary collaboration and knowledge exchange among international leaders in the field. As committed members of the GNC/GLC, we remain dedicated to advancing hepatology research, promoting patient-centered models of care, and supporting policy initiatives that strengthen global awareness of liver disease, particularly MASLD as a major non-communicable disease of growing public health significance. We look forward to continued productive collaboration in our shared mission to improve liver health outcomes worldwide.

Paris International Liver Meeting 2027 – Save the Date

Dear Colleagues, We are pleased to invite you to save the date for the Paris International Liver Meeting 2027, taking place January 21–23, 2027, at Maison de la Chimie in Paris, France. Building on the outstanding success of PILM 2026, which attracted 722 participants from 67 countries, we are excited to bring together the international community of hepatology experts once again. PILM 2027 will feature cutting-edge scientific sessions, state-of-the-art lectures, and interactive discussions covering the latest advances in steatotic liver disease (MASLD, MetALD, ALD), viral hepatitis, hepatocellular carcinoma, cholestatic liver diseases, and complications of cirrhosis. Join us to share insights, exchange practical approaches, and advance patient care alongside colleagues from academia, clinical practice, and industry. For more information, visit www.parislivermeeting.com We look forward to seeing you in Paris! Best regards, Laurent Castera and Zobair M. Younossi

Research from Global NASH/MASH Council as Cover Story of Lancet Gastroenterology & Hepatology: Hidden Impact of Alcohol Underreporting on Disease Burden in the US

Research by the Global NASH/MASH Council (GNC), led by Zobair M. Younossi, MD, has been published as the Cover Story of The Lancet Gastroenterology & Hepatology. Using National Health and Nutrition Examination Survey (NHANES) data spanning 1988–2023, the study demonstrates that alcohol consumption is underreported in population surveys, resulting in underestimation of alcohol-related liver disease (ALD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) burden. When corrected for underreporting, the prevalence of ALD and MetALD nearly doubled compared to uncorrected estimates. The research reveals that ALD carries the highest premature mortality risk among steatotic liver diseases (SLD), with binge drinking identified as the dominant mortality driver in ALD and type 2 diabetes (T2D) as the strongest predictor in metabolic dysfunction-associated steatotic liver disease (MASLD). Notably, the concurrent presence of binge drinking with T2D or hypertension produces synergistic effects associated with particularly hazardous outcomes. These findings underscore the urgent need for systematic screening of alcohol consumption, with particular emphasis on binge drinking, combined with comprehensive assessment of cardiometabolic risk factors. Such integrated approaches are essential to inform targeted clinical interventions and public health strategies aimed at preventing liver disease progression, reducing mortality, and improving patient outcomes. Read the full article: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(25)00376-0/abstract

New Global Consensus Roadmap for MASLD: From Risk Identification to Actionable Care

Metabolic dysfunction-associated steatotic liver disease (MASLD) now affects more than one-third of the global adult population and has become an increasingly important driver of cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related mortality. The newly accepted global consensus recommendations in Clinical Gastroenterology and Hepatology (2026) provide a practical roadmap to help clinicians move from passive disease recognition to proactive, risk-stratified management. Central to this paradigm shift is a fundamental principle: fibrosis risk, rather than steatosis alone, should guide clinical decision-making. Patients with type 2 diabetes, medically complicated obesity, persistent aminotransferase elevation, or multiple cardiometabolic risk factors warrant active risk stratification using first-line noninvasive testing with FIB-4. This approach enables primary care clinicians to rapidly distinguish low-risk patients suitable for routine management from those requiring further assessment and potential specialist referral. The algorithm employs a two-tiered stratification strategy. Second-line noninvasive tests, vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) score, further define disease severity and guide actionable decisions. These tools identify patients with low-risk disease, those with at-risk MASLD and clinically significant fibrosis (F2–F3) where intervention is most impactful, and those with probable cirrhosis who require specialist management. Patients with F2–F3 fibrosis without cirrhosis may be considered for MASH-approved regimens in addition to lifestyle modification. Those with cirrhosis, while not currently candidates for approved MASH pharmacotherapies, should be referred for specialist management, whereas patients with earlier-stage disease (F1) can generally remain under primary care management. Critically, this framework transforms noninvasive tests from diagnostic tools into treatment-enabling instruments. For the first time, the consensus also provides clear threshold-based recommendations for both VCTE and ELF in risk stratification and treatment selection. It further integrates recently approved pharmacotherapies, resmetirom and semaglutide, for appropriate noncirrhotic patients with moderate-to-advanced fibrosis (F2–F3), while emphasizing foundational lifestyle interventions: weight reduction, Mediterranean-style dietary optimization, alcohol minimization, reduction of ultra-processed foods and sugar-sweetened beverages, and regular physical activity. Longitudinal monitoring with repeat noninvasive testing during follow-up or active treatment allows objective assessment of treatment response and refinement of management over time. The future of MASLD care is decisively noninvasive, risk-stratified, scalable, and actionable, combining evidence-based pharmacotherapy with optimized lifestyle modification and comprehensive cardiometabolic risk management for eligible patients. Read the full article: https://www.cghjournal.org/article/S1542-3565(26)00241-7/fulltext

Binge drinking, metabolic dysfunction, and the spectrum of steatotic liver disease in the USA: a cross-sectional and longitudinal analysis

A new study shows that we have been underestimating alcohol related liver disease. Published this week in The Lancet Gastroenterology and Hepatology by members of the Global NASH MASH Council, this large US study using NHANES data from 1988 to 2023 and including 41,100 adults highlights a major issue. Underreporting alcohol use is leading to widespread misclassification of liver disease. Many patients labeled as MASLD may in fact have ALD or MetALD. After adjusting for underreporting, the prevalence of both ALD and MetALD nearly doubled. The mortality signal is striking. Binge drinking drives most premature deaths in ALD at 92.9 percent and contributes significantly in MetALD at 21 percent, while type 2 diabetes remains a major driver in MASLD at up to 44.8 percent. The highest risk occurs when these factors coexist, particularly binge drinking combined with diabetes or hypertension, which is associated with up to a seventeen-fold increase in mortality. The bottom line is clear. We need to move beyond self-reported alcohol intake. Routine assessment of underreported alcohol use with tools such as AUDIT or biomarkers such as PEth, along with careful evaluation of binge drinking patterns, should become standard clinical practice. Misclassification is not benign; it leads to missed opportunities for intervention and underestimates the true burden of disease.

EASL 2026: Accepted Abstracts – Center for Outcomes Research in Liver Diseases