Fibroscan

MASLD refers to the accumulation of fat in the liver, most often linked to overweight and metabolic disorders.

Not all patients develop complications. However, about 25% develop chronic liver inflammation, known as MASH (Metabolic dysfunction-associated steatohepatitis).

MASH can progressively damage the liver silently, sometimes leading to cirrhosis without visible symptoms.

• Around 25% of the population has MASLD
• Among them, 10–30% develop advanced fibrosis
• Some patients progress to cirrhosis
• There is then a risk of liver cancer (hepatocellular carcinoma)

In the coming years, MASH is expected to become one of the leading causes of liver transplantation in Europe.

MASLD is not only a liver disease.

Patients have an increased risk of:

• Cardiovascular complications (heart attack, stroke)
• Liver complications in case of severe fibrosis
• Certain extrahepatic cancers:
  • Colon
  • Pancreas
  • Breast
  • Endometrium

Colorectal cancer screening is recommended from age 45 in these patients.

Main factors promoting MASH include:

• Metabolic syndrome (overweight, diabetes, hypertension, high cholesterol)
• Diet rich in sugars, especially fructose
• Lack of physical activity

By definition, patients with MASH do not consume alcohol or only in moderation.

In MASLD, the most important factor predicting disease progression is the degree of fibrosis (liver scarring).

The more advanced the fibrosis, the higher the risk of:

• Liver complications
• Cardiovascular diseases
• Certain cancers

This is why assessing fibrosis is essential.

Fat in the liver is usually detected through simple, non-invasive tests:

• Abdominal ultrasound
• CT scan

To diagnose inflammation (MASH), the gold standard remains liver biopsy. However, it is invasive, costly, and carries a small risk of complications.

Currently, no fully validated non-invasive test exists to diagnose MASH, although research is ongoing.

Fortunately, several tools are now available to assess fibrosis without the need for a biopsy:

1. Blood tests (biological scores)

• FIB-4
• NAFLD Fibrosis Score

These scores use simple parameters (age, blood test results) to estimate the risk of fibrosis.

2. Elastography (measurement of liver stiffness)
The most well-validated and reproducible technique in MASLD is FibroScan®.

Used for more than 20 years and available in Belgium since 2007 at CHIREC—where the first Belgian study was conducted—FibroScan® is a quick, painless, non-invasive, and reproducible test that assesses both fibrosis and the amount of fat in the liver.

Since the opening of Delta Hospital in 2018, a latest-generation FibroScan® has been available in gastroenterology consultations (also at the Braine-l’Alleud site).

It is a simple, painless, and non-invasive test that quickly evaluates liver health.

In just a few minutes, it measures:

• The amount of fat in the liver
• The degree of fibrosis

Two types of probes are available, including one specifically adapted for overweight or obese patients to ensure reliable results.

FibroScan® is:

• Quick
• Painless
• Radiation-free
• Performed during consultation
• Reproducible (useful for follow-up over time)

It helps to:

• Assess the risk of complications
• Guide treatment decisions
• Avoid liver biopsy in most cases

FibroScan® is particularly recommended for:

• People with metabolic syndrome
• Diabetic patients
• Overweight or obese individuals
• Patients with cardiovascular history
• People with abnormal liver tests
• Patients over 60 years old

Management of Metabolic dysfunction-associated steatotic liver disease (MASLD) is primarily based on lifestyle changes.

In most patients, weight loss is essential: losing around 10% of body weight can already:

• Reduce fat in the liver
• Improve fibrosis (liver scarring)

The foundations of treatment are:

• A Mediterranean-style diet
• Reduced sugar intake (especially fructose)
• Nutritional/dietary support
• Regular physical activity

New medications offer promising results:

• Some diabetes and weight-loss drugs (GLP-1 analogues) have shown:
  • Improvement in liver inflammation
  • Improvement in early fibrosis
  • Cardiovascular benefits
• Resmetirom has been approved in the United States for certain forms of MASLD with moderate fibrosis.

MASLD is often silent (without symptoms).

It is important to screen at-risk individuals and assess fibrosis, particularly using FibroScan®, a simple, fast, and non-invasive test.

Coordinated care between general practitioners and specialists is essential to protect both the liver and the heart.