Fatty liver on an incidental scan two years ago and nobody followed it up. Now that I am losing weight I would like to know what to re-measure.
With resmetirom now available for MASH, combination approaches are being explored, so the standard of care in this area is moving faster than most threads assume.
What I actually want to know is whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is.
Happy to be told the question itself is wrong.
tony_orlando said:Fatty liver on an incidental scan two years ago and nobody followed it up.
NASH/MAFLD therapeutic landscape and liver and MASH: GLP-1 agonists are emerging as potential first-line NASH therapy. The Phase 2b data for semaglutide showed 59% NASH resolution (vs 17% placebo) with 43% achieving fibrosis improvement[1].
Mechanism: GLP-1R activation reduces hepatic lipogenesis, increases fatty acid oxidation, reduces hepatic inflammation, and may directly reduce hepatic stellate cell activation (fibrosis pathway).
With resmetirom (thyroid hormone receptor agonist) recently approved for NASH, the field is evolving rapidly. Combination approaches (GLP-1 + resmetirom) are being explored.
[1] Newsome PN, et al. N Engl J Med. 2021;384(12):1113-1124.
sarah.morrison said:NASH/MAFLD therapeutic landscape and liver and MASH: GLP-1 agonists are emerging as potential first-line NASH therapy.
Liver imaging follow-up for liver and MASH: FibroScan at baseline showed CAP score 312 dB/m (moderate steatosis) and stiffness 8.8 kPa (possible fibrosis). Diagnosed with NAFLD.
After 10 months: CAP dropped to 225 dB/m (minimal steatosis) and stiffness normalized to 4.8 kPa. Hepatologist says the liver is essentially healing itself as the metabolic stress resolves.
GLP-1 agonists may become first-line NASH therapy. The Phase 3 data on semaglutide for NASH is very promising.
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Shop Reference Standardstony_orlando said:Fatty liver on an incidental scan two years ago and nobody followed it up.
Same pattern here, and in the same order.
Clinical perspective, offered as context rather than as advice.
Liver enzyme update related to liver and MASH: I had mildly elevated ALT/AST at baseline (likely NAFLD). After 11 months on GLP-1 therapy:
| Marker | Baseline | Current | Normal Range |
|---|---|---|---|
| ALT | 62 | 29 | 7-56 U/L |
| AST | 65 | 25 | 10-40 U/L |
| GGT | 82 | 33 | 9-48 U/L |
| ALP | 112 | 74 | 44-147 U/L |
FibroScan also improved — liver stiffness from 10.5 kPa to 6.2 kPa. The evidence for GLP-1 agonists in NAFLD/NASH is very promising.