What are the MASH (Model for Ash and Smoke Hazard in the Lungs, Diabetes) criteria?

From the Guidelines

The MASH criteria are a set of diagnostic criteria used to identify metabolic dysfunction-associated steatohepatitis (MASH), which include suggested initial tests such as FibroScan CAP ≥280 dB/m, AST >17 IU/L for females or >20 IU/L for males, and subsequent tests to identify significant/advanced fibrosis including VCTE ≥10 kPa, ELF ≥9.2, or MRE ≥3.0 kPa, as proposed by an expert panel in 2024 1. To meet the MASH criteria, patients must undergo initial tests to identify presumed MASH, which include:

• FibroScan CAP ≥280 dB/m
• Alternative steatosis assessment options such as quantitative assessments of MRI-proton density fat fraction ≥5% or qualitative assessments with a CAP score ≥280 dB/m, which should be used with at least one of the parameters listed below
• AST >17 IU/L for females or >20 IU/L for males, similar to the inclusion criteria for MAESTRO-NASH Subsequent tests to identify the presence of significant/advanced fibrosis include:
• VCTE ≥10 kPa, with recommended best practices such as obtaining >10 measurements, achieving an interquartile range <30%, and having the patient fast for at least 3 hours before the measurement
• ELF ≥9.2, with ELF 9.2–9.7 requiring an additional non-invasive test to corroborate likely stage 2 or 3 fibrosis, and ELF 9.8–10.4 being used to identify patients for treatment with resmetirom when TE is not available
• MRE ≥3.0 kPa, with MRE 4.4–4.9 requiring additional caution to exclude the presence of cirrhosis These criteria help clinicians identify patients at risk for progressive liver disease who may benefit from treatment with resmetirom, as recommended by the expert panel in 2024 1.

From the Research

MASH Criteria

The MASH criteria are not directly mentioned in the provided studies. However, the studies discuss the criteria for diagnosing metabolic dysfunction-associated steatotic liver disease (MASLD) and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH).

• The diagnosis of MASLD requires at least one of five cardiometabolic criteria 2.
• The criteria for MASLD include evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation 3.
• The cardiometabolic criteria can be used as predictors and treatment targets for cardiovascular event risk in MASLD 2.
• There is no direct mention of the MASH criteria in relation to the Model for Ash and Smoke Hazard in the Lungs, Diabetes.

Related Criteria

The studies provide information on the criteria for diagnosing MASLD and MASH, which are related to metabolic dysfunction and liver disease.

• The criteria for MASLD include overweight/obesity, type 2 diabetes mellitus, and metabolic dysregulation 3.
• The cardiometabolic criteria for MASLD can be used to predict and treat cardiovascular event risk 2.
• The studies do not provide information on the MASH criteria in relation to the Model for Ash and Smoke Hazard in the Lungs, Diabetes, as this appears to be a different context.

Study Findings

The studies provide findings on the diagnosis, treatment, and management of MASLD and MASH.

• The diagnosis of MASLD requires evidence of hepatic steatosis and at least one of the cardiometabolic criteria 2, 3.
• The treatment of MASLD includes lifestyle modifications, such as improved diet and increased exercise, and surgical interventions, such as bariatric surgery and intragastric balloons 4.
• The studies highlight the importance of early diagnosis and intervention in preventing the progression of MASLD to cirrhosis and its complications, including cancer 5, 6.