Recognizing MASLD Risk and Progression

In the second video of this series, PA Joseph Zucchi introduces metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). He walks through the disease spectrum, from hepatic steatosis to MASH, progressive fibrosis, and cirrhosis.

PA Zucchi also shares prevalence data showing that about 75% of people with obesity have MASLD, and he outlines the overlapping risk factors that should prompt PAs to look for this often-asymptomatic disease.

Key Takeaways:

MASLD is a spectrum of disease that spans hepatic steatosis through MASH, fibrosis, and cirrhosis.
There is a bidirectional relationship between obesity and MASLD that is mediated by inflammation.
MASLD and obesity are associated with increased cardiometabolic risk.

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Speaker

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Joseph Zucchi, PA-C, MPAS

References and Additional Resources:

Cusi K, Abdelmalek MF, Apovian CM, et al. Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) in people with diabetes: the need for screening and early intervention. a consensus report of the American Diabetes Association. Diabetes Care. 2025;48(7):1057–1082. https://diabetesjournals.org/care/article/48/7/1057/160536/Metabolic-Dysfunction-Associated-Steatotic-Liver

Luo Y, Lin H. Inflammation initiates a vicious cycle between obesity and nonalcoholic fatty liver disease. Immun Inflamm Dis. 2021 Mar;9(1):59-73. https://pubmed.ncbi.nlm.nih.gov/33332766/

Miller DM, McCauley KF, Dunham-Snary KJ. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): mechanisms, clinical implications and therapeutic advances. Endocrinol Diabetes Metab. 2025;8(6):e70132. https://pubmed.ncbi.nlm.nih.gov/41255342/

Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20-30. https://pubmed.ncbi.nlm.nih.gov/36400097/

Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 2023;78(6):1966–1986. https://journals.lww.com/hep/fulltext/10.1097/hep.0000000000000520~a-multisociety-delphi-consensus-statement-on-new-fatty-liver

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. https://pubmed.ncbi.nlm.nih.gov/36727674/

Targher G, Byrne CD, Tilg H. MASLD: a systemic metabolic disorder with cardiovascular and malignant complications. Gut 2024;73(4):691-702. https://pubmed.ncbi.nlm.nih.gov/38228377/

Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): A systematic review. Hepatology. 2023; 77(4): 1335–1347. http://pubmed.ncbi.nlm.nih.gov/36626630/

Younossi ZM, Kalligeros M, Henry L. Epidemiology of metabolic dysfunction-associated steatotic liver disease. Clin Mol Hepatol. 2025;31(Suppl):S32-S50. https://pmc.ncbi.nlm.nih.gov/articles/PMC11925440/

Supported by

Joseph Zucchi, PA-C, MPAS

Joseph Zucchi is the Clinical Supervisor and physician associate at Transition Medical Weight Loss in Salem, New Hampshire, where he leads a multidisciplinary obesity medicine program dedicated to comprehensive care. Under his clinical leadership, Transition has helped patients achieve more than 60,000 pounds of collective weight loss while making meaningful improvements in their health.

PA Zucchi serves on the board of the New England Obesity Society and as a clinical preceptor for physician associate students at MCPHS University. He is also a national speaker and advisor in obesity medicine, educating healthcare professionals on obesity as a chronic disease, anti-obesity medications, cardiometabolic health, and strategies to improve patient outcomes.

A passionate advocate for people living with obesity, PA Zucchi is actively involved in efforts to improve treatment access, advance obesity care, and challenge the stigma and misconceptions surrounding the disease. He has authored numerous articles and op-eds, appeared on podcasts and professional educational programs, and his expertise has been featured in The Wall Street Journal, The New York Times, Bloomberg, USA Today, Forbes Health, Medscape, The Boston Globe, and other national media.