Paving the paths for interdisciplinary MASLD care Towards improved integration of metabolic dysfunction-associated steatotic liver disease in cardiometabolic medicine

This thesis contains studies that provide key building blocks for integrating metabolic dysfunction–associated steatotic liver disease (MASLD) into interdisciplinary cardiometabolic care. The work is structured into three parts, each addressing complementary approaches d to shape future MASLD care.
Part I frames MASLD as a multidisciplinary cardiometabolic condition. A narrative review demonstrates epidemiological and pathophysiological links between MASLD and cardiovascular disease, highlighting shared risk factors and overlapping therapeutic opportunities. An international questionnaire study reveals substantial gaps in awareness and management of MASLD among physicians treating cardiometabolic patients, particularly cardiologists. These findings underscore the need for hepatology-led multidisciplinary collaboration.
Part II focuses on MASLD biology in a cardiometabolic context, using human material from the ANCHOR cohort. One study maps β-Klotho expression across tissues and disease stages, showing preserved hepatic expression even in advanced MASLD, supporting the therapeutic potential of FGF-based strategies. Another study identifies HDL-derived proteins that discriminate steatohepatitis from isolated steatosis and may enhance non-invasive diagnostic accuracy when combined with quantitative MRI.
Part III addresses the implementation of MASLD care in primary care. It demonstrates that two-step screening pathways combining blood-based tests and elastography effectively detect advanced fibrosis in at-risk populations. A qualitative study among general practitioners shows that successful implementation depends on alignment with professional identity, collaboration across care levels, and organisational continuity. A final viewpoint outlines system-level requirements for scalable and sustainable screening strategies.
Together, these studies integrate biological, clinical, and implementation perspectives, positioning MASLD firmly within the cardiometabolic disease spectrum and providing a blueprint for interdisciplinary care.