What is MASLD?
MASLD stands for metabolic-associated steatotic liver disease. It replaced the older term NAFLD (non-alcoholic fatty liver disease) in 2023. The new name reflects the underlying cause: metabolic dysfunction (high BMI, type 2 diabetes, metabolic syndrome) rather than the absence of alcohol.
MASLD is defined by fat accumulation in the liver (visible on ultrasound or by elevated CAP/UAP on elastography) plus at least one cardiometabolic risk factor.
MASLD prevalence in Australia
- Roughly 30% of Australian adults have MASLD on imaging
- Around 65% of patients with type 2 diabetes have MASLD — the prevalence is dominant in metabolic clinics
- About 25% of MASLD progresses to MASH (the inflammatory form)
- An estimated 5–10% of MASH progresses to cirrhosis over a decade
These numbers explain why MASLD is the fastest-growing cause of liver disease worldwide — and why MASLD-related liver cancer (HCC) is increasing.
What is MASH?
MASH (metabolic-associated steatohepatitis) is the inflammatory form of MASLD. The fat in liver cells triggers inflammation, which scars the liver over time (fibrosis). Without treatment, MASH can progress to cirrhosis and eventually liver failure or cancer.
MASH is staged by fibrosis level (F0 to F4, where F4 is cirrhosis). Most monitoring is non-invasive: FIB-4 blood score, then elastography for liver stiffness in kilopascals.
Semaglutide approved for MASH (FDA, August 2025)
The FDA approval was driven by the ESSENCE Phase 3 trial: semaglutide produced histological MASH resolution in 62.9% of treated patients (vs 17% on placebo) and fibrosis improvement in 36.8%. This was the largest treatment effect seen in any MASH drug program to date.
The AASLD updated its guidance in November 2025 to include semaglutide as a treatment option. The 2026 EASO guideline positions both semaglutide and tirzepatide in the MASH treatment algorithm.
In Australia, TGA approval for the MASH indication specifically is anticipated. Off-label use by metabolic specialists and GPs is already common, and Wegovy (the higher-dose semaglutide for weight management) is TGA-approved.
Why elastography matters in the GLP-1 era
The challenge with MASH treatment is identifying who actually has it. Most patients with MASLD don't have MASH. Treating with a high-cost drug like semaglutide before staging fibrosis is inefficient — and tracking treatment response without an objective marker is impossible.
Elastography solves both problems. A baseline kPa measurement stages fibrosis. A repeat kPa at 12 months shows treatment effect. A reduction of ≥5 kPa is clinically meaningful under Baveno VII criteria.
Frequently asked questions
Does Mounjaro treat fatty liver?
Tirzepatide (Mounjaro) trial data shows large reductions in liver fat and meaningful fibrosis improvement, with histological MASH resolution in over 60% of treated patients in SYNERGY-NASH. It's not yet FDA-approved specifically for MASH but is widely used off-label.
Can Ozempic reverse MASH?
ESSENCE Phase 3 data shows semaglutide resolved MASH histologically in 62.9% of treated patients vs 17% on placebo. Reversal happens in many but not all patients — the response is greater in earlier-stage disease.
What is the difference between MASLD and MASH?
MASLD is fat in the liver with metabolic risk factors. MASH is MASLD with inflammation and active liver damage. About 25% of MASLD progresses to MASH. Elastography helps identify who has the more serious form.
How is MASH diagnosed in Australia?
First-line is FIB-4 blood score. If indeterminate, elastography measures liver stiffness in kPa. A kPa above 8 in a MASLD patient typically suggests significant fibrosis warranting specialist review.
Find a liver elastography clinic near you
Search participating clinics across Australia, or talk to your GP about a baseline FIB-4 and elastography.
This page is educational and not medical advice. Always discuss your GLP-1 treatment and liver monitoring with your GP.