by Before the U.S. Food and Drug Administration (FDA) approval of resmetirom (Rezdiffra), the first liver-directed therapeutic for metabolic dysfunction-associated steatohepatitis (MASH), weight loss was the cornerstone of disease treatment.
Although drug treatment is now available for patients with noncirrhotic MASH, weight loss remains an important aspect of disease management, with diet and nutrients playing a particularly important role in patients’ chances of success.
In a presentation at the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) Conference in National Harbor, Maryland, Tessa Janovsky, PA-C, a physician assistant at Arizona Liver Health, discussed the role of nutrition in the treatment of MASH and liver cirrhosis, describing it as “one of the most important things to discuss with a patient” in an interview with HCPLive.
“Diet can really make or break success, especially in MASH, when we talk about the need to adjust diet, reduce sugar consumption, reduce carbohydrate consumption. All of that is going to be vital for the liver in the long run to reduce the amount of carbohydrates and sugar that the liver has to process,” she explained. “When we talk about cirrhosis, diet may or may not be critical for the patient… As much as we can optimize our patients’ diet, hopefully we will set them up for more success in terms of their liver, morbidity and mortality.”
Janovsky described the best nutritional intervention as one that patients can stick to, noting that it looks different for everyone and is not a “one size fits all” approach. In particular, she drew attention to cultural differences in nutrition that may affect patients’ eating habits and what dietary changes are most realistic for them compared to their usual diet.
Janovsky recognized both drugs and nutrition as pillars of therapy, pointing out that resmetirom is approved in conjunction with diet and physical activity. She also pointed out the benefits of diet and exercise in patients with advanced liver disease, for whom resmetirom is not currently an option. With regard to diet and nutrition in particular, Janovsky emphasized the importance of a multidisciplinary approach with endocrinologists and nutritionists.
“[Diet] can be a sensitive subject for many patients,” she said. “Even if you spend 5 extra minutes with a patient, just talking to them and finding out what works for them, patients really appreciate that. I want to encourage providers to think outside the box and look at what concerns the patient more.”
References
- Brooks, A. Resmetirom (Rezdiffra) receives historic FDA approval for noncirrhotic NASH. HCPLive. March 14, 2024. Accessed September 12, 2024. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash
- Brooks, A. Stephen Harrison, MD: The role of weight loss and resmetirom in the treatment of NASH. HCPLive. March 18, 2024. Accessed September 12, 2024. https://www.hcplive.com/view/stephen-harrison-md-weight-loss-resmetirom-nash-management
