The recent FDA approval of resmetirom (Rezdiffra) as the first liver-directed therapeutic for metabolic dysfunction-associated steatohepatitis (MASH) has not diminished the critical role of nutrition and weight loss in disease management, according to experts at the 2024 Gastroenterology and Hepatology Advanced Practice Providers conference.
Tessa Janovsky, PA-C, from Arizona Liver Health, emphasized that dietary interventions remain a cornerstone of MASH treatment, working in conjunction with new pharmacological options. "Nutrition really can guide outcomes, especially with MASH when we talk about the need to adjust the diet, lower the sugar intake, lower the carbohydrate intake. That's all going to be vital for the liver in the long run," she explained.
Personalized Nutritional Approaches
The most effective dietary interventions are those that patients can consistently maintain, with Janovsky stressing that there is no "one size fits all" approach. Cultural considerations play a significant role in dietary recommendations, as healthcare providers must account for patients' traditional eating habits when suggesting nutritional modifications.
"Diet can be a touchy subject for a lot of patients," Janovsky noted, emphasizing the importance of taking time to understand individual patient circumstances. She encourages providers to "think outside the box" when developing treatment plans that align with patient preferences and lifestyle patterns.
Integrated Treatment Strategy
While resmetirom has been approved for noncirrhotic MASH patients, it is specifically indicated for use in combination with diet and physical activity. For patients with more advanced liver disease who may not qualify for resmetirom treatment, nutrition becomes even more crucial.
"When we talk about cirrhosis, nutrition can kind of make or break a patient outcome," Janovsky stated. "As best as we can optimize our patient nutritionally, we're going to set them up for more success down the line, hopefully, when it comes to their liver, morbidity, and mortality."
Multidisciplinary Care Approach
The complexity of MASH management necessitates a collaborative approach. Janovsky advocates for involving endocrinologists and nutritionists in patient care, particularly when addressing dietary modifications and metabolic aspects of the disease. This team-based strategy ensures comprehensive patient support and optimal treatment outcomes.
