Author: *Anastasia Ntikoudi1,2
1. WHO Athens Office Quality of Care and Patient Safety, Greece
2. University of West Attica, Aigaleo, Greece
*Correspondence to [email protected]
Disclosure: The author has declared no conflicts of interest.
Keywords: Cardiometabolic disease, exercise, hepatocellular carcinoma, lifestyle intervention, MASLD, multidisciplinary care, pharmacological therapy, psychological health, weight loss.
Citation: EMJ Hepatol. 2026;14[1]:43-45. https://doi.org/10.33590/emjhepatol/41MM19B0
A key challenge for clinicians is communicating risk effectively to patients. Many individuals perceive MASLD as a relatively benign condition because they are often asymptomatic.1 However, helping patients understand the broader cardiometabolic implications of MASLD may improve engagement with treatment and support long-term behavioural change.1,2 Explaining that liver disease progression is only one component of the overall risk profile can help patients appreciate the importance of sustained lifestyle modification.2,3
Lifestyle intervention remains the cornerstone of MASLD management, despite the emergence of new pharmacological therapies.3-5 Weight loss remains the most effective treatment strategy, with evidence showing that reductions in body weight can improve hepatic steatosis, resolve steatohepatitis in some patients, and reduce fibrosis progression.1,3,6 Rather than focusing on individual nutrients, clinicians should encourage sustainable dietary patterns that create a long-term energy deficit and improve overall diet quality.6,7 Practical approaches include reducing consumption of ultra-processed foods and sugar-sweetened beverages, increasing intake of minimally processed foods, and tailoring recommendations to individual cultural preferences and socioeconomic circumstances.6,7 Physical activity should be promoted as a therapeutic intervention in its own right. Exercise improves insulin sensitivity, reduces liver fat, and enhances cardiometabolic health, even in the absence of substantial weight loss.6,7 Helping patients identify enjoyable and achievable forms of activity may be more effective than prescribing rigid exercise programmes. Current recommendations continue to support regular moderate-intensity aerobic activity combined with resistance training where feasible.1,3,6
The growing role of weight-lowering medications, particularly glucagon-like peptide-1 receptor agonists and related incretin-based therapies, represents one of the most significant developments in MASLD management.5-9 These agents can produce clinically meaningful weight loss and may improve liver-related outcomes in selected patients.8-10 Nevertheless, experts increasingly emphasise that pharmacological treatment should complement rather than replace lifestyle intervention.10 Long-term success depends on maintaining behavioural changes that support weight management and overall metabolic health.3,8
An often underappreciated aspect of MASLD management is the impact of mental health. Anxiety, depression, stress, and other psychological conditions are common among individuals living with obesity and metabolic disease, and may significantly influence adherence to dietary and physical activity recommendations.6,7 Identifying and addressing psychological barriers is therefore critical. Behavioural support, motivational interviewing, and integration of mental health professionals into multidisciplinary care pathways may improve patient engagement and long-term outcomes.8
The European Association for the Study of the Liver (EASL) 2026 forum reinforces the ongoing shift from a liver-centric model of care towards a comprehensive cardiometabolic approach. As new therapies become available, successful management of MASLD will increasingly depend on interprofessional collaboration that combines evidence-based lifestyle intervention, appropriate use of pharmacotherapy, and attention to the psychological and social factors that influence behavioural change.1,6-10
