When Baffled About NAFLD and MAFLD: Key Takeaways from Dr. Adam Morawski
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common in primary care, but identifying which patients are at risk—and translating lifestyle recommendations into meaningful, sustainable change, can be challenging.
In a recent Alethea Learning Session, Dr. Adam Morawski, MD, CCFP, DipABLM, shared a practical approach to MASLD management, with a focus on fibrosis risk assessment and evidence-based lifestyle interventions that can be incorporated into everyday primary care.
Looking Beyond the Liver
One of the central themes of the session was the importance of viewing MASLD as a metabolic disease rather than simply a liver abnormality. The updated terminology reflects the close relationship between hepatic steatosis and cardiometabolic risk factors such as obesity, prediabetes or diabetes, hypertension, and dyslipidemia.
For Primary Care Providers, this means considering the broader metabolic picture when identifying and managing patients at risk.
Risk Stratification in Primary Care
Dr. Morawski also discussed the role of FIB-4 as an accessible tool for fibrosis risk stratification. It can help PCPs determine which patients may be appropriate to continue managing in primary care and which may benefit from additional investigation or referral to hepatology.
The session explored practical thresholds and next steps based on FIB-4 results, as well as the potential role of HOMA-IR in selected patients.
Lifestyle Medicine Goes Beyond “Diet and Exercise”
Nutrition and weight management were important parts of the discussion, but Dr. Morawski emphasized a much broader approach. He framed MASLD management around the six pillars of lifestyle medicine: nutrition, physical activity, restorative sleep, stress management, social connectedness, and avoidance of risky substances.
Importantly, providers don’t need to address every pillar at once. Identifying one or two areas where a patient needs the greatest support can make lifestyle changes more realistic and sustainable.
Turning Recommendations Into Behaviour Change
Simply telling a patient to “eat better” or “exercise more” is rarely enough. Dr. Morawski highlighted motivational interviewing, SMART goals, regular follow-up, and multidisciplinary support as practical ways to help patients turn recommendations into specific behaviours they can maintain over time.
Want to Dive Deeper?
The full learning session notes include Dr. Morawski’s discussion of FIB-4 thresholds, nutrition and weight loss, exercise, sleep and stress, behaviour-change strategies, follow-up, and practical approaches to MASLD management.
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