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MASLD 2025: Detailed Case Based discussion by Dr. Om J Lakhani To access all the detailed content, mini-applications and get a certificate of participation please enroll for free on the link given below on Technocrinology.com https://technocrinology.thinkific.com... MASLD 2025: Detailed Case Based Discussion by Dr. Om J Lakhani Introduction (0:00-1:45) Overview of MASLD diagnosis and treatments Technocranology platform introduction with additional materials QR code for mobile access to presentation Case Introduction (1:46-3:20) Mr. Kumar: 45yo male executive, routine health checkup No symptoms, previous checkup 5 years ago Family history: T2DM (mother/brother), father had stroke at 45 Personal: 20g alcohol/day, sedentary, daytime somnolence Clinical Parameters (3:21-5:00) BMI: 28.4 (obese by Indian standards) Waist: 102cm, elevated BP, acanthosis nigricans Labs: HbA1c 6.2, elevated liver enzymes Ultrasound: Grade 1 fatty liver Key insight: "The disease is adiposity" - T2DM and MASLD are consequences Metabolic Assessment (5:01-8:30) Patient fits metabolic syndrome criteria TYG index better than HOMA-IR: log(fasting glucose × triglycerides) Patient's TYG: 9.59 (insulin resistance cutoff: 4.5) MASLD Classifications (8:31-12:00) MASLD: metabolic-associated steatotic liver disease MASH: metabolic-associated steatohepatitis (formerly NASH) METALD: metabolic + alcoholic liver disease Alcohol criteria: MASLD (males: under 30g/day) "Two-hit concept": Combined factors accelerate progression Diagnosis Parameters (12:01-15:00) SGPT cutoff: 35+ in men (patient: 57) AST/ALT ratio: 2:1+ suggests alcoholic pattern, under 1 suggests MASLD Diagnosis requires: fatty liver, minimal alcohol, metabolic factors Imaging Assessment (15:01-21:00) Ultrasound: good for diagnosis, poor for grading Fatty liver grades: Grade 1: Portal vein visible Grade 2: Portal vein invisible, diaphragm visible Grade 3: Neither visible FIB-4 score: patient's 1.64 (intermediate, needs Fibroscan) Fibroscan Explained (21:01-27:30) Measures: CAP (steatosis) and LSM/kPa (fibrosis) CAP values: Under 238: No steatosis 238-260: Mild 260-290: Moderate 290+: Severe LSM/kPa values: 2.4-5.5: Normal 5.5-8: F1 fibrosis 8.1-10.8: F2 10.9-14.2: F3 15+: Cirrhosis Patient: CAP 280 (moderate), F2 fibrosis MRI Assessment (27:31-30:45) Emerging techniques: MRI-PDFF: steatosis MR elastography: fibrosis CT1 MRI: steatohepatitis May replace biopsies for steatohepatitis Management (30:46-33:20) F2 fibrosis requires intervention Options: lifestyle, medications, follow-up Bariatric surgery for select cases Lifestyle Measures (33:21-34:05) Target 7-10% weight loss for steatosis Physical activity, dietary changes No safe alcohol level - patient should stop 20g/day Pharmacological Options (34:06-40:00) Pharma focus areas: Obesity and MASLD Treatment categories: Repurposed T2DM medications MASLD-specific drugs CV risk reduction (statins, aspirin) Vitamin E (800 IU/day) for non-diabetics Approved Treatments (40:01-47:15) FDA-approved: Resmetirom (thyroid receptor-β agonist) Targets intrahepatic hypothyroidism Shows fibrosis regression Patent expiring soon India-approved: Saroglitazar Dual PPAR-α/γ agonist EVIDENCES trials support efficacy Repurposed Antidiabetics (47:16-54:15) SGLT-2 inhibitors: E-LIFT trial positive GLP-1 agonists: Semaglutide: 59% MASH resolution Tirzepatide: promising results Pioglitazone: anti-fibrotic effects (diabetics only) Vitamin E Evidence (54:16-55:10) PIVENS trial: 800 IU/day benefits non-diabetics Improves NASH, reduces ALT, steatosis, inflammation Case Recommendations (55:11-56:35) For Mr. Kumar (non-diabetic with F2 fibrosis): 7-10% weight loss Vitamin E 800 IU/day Saroglitazar Statin therapy Consider tirzepatide for weight loss Conclusion (56:36-57:25) Certificate available through Technocranology Complete all materials to receive coded certificate