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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Primary Care

Building Your Care Team and Preparing for Your First Visit

At a Glance

Building a coordinated MASH care team can connect liver, diabetes, heart, nutrition, and weight management needs. Bring recent lab trends, imaging reports, and a complete medication and supplement list to your first specialist visit so your clinician can assess liver scarring and plan care.

Navigating a MASH diagnosis can feel like managing several different health conditions at once. Because the liver is the central hub for your body’s metabolism, its health is tied to your heart, your blood sugar, and your weight [1].

To manage this effectively, you need a coordinated approach. Many people with low-risk MASH can be managed successfully by primary care with targeted referrals. However, depending on your risk factors, diabetes control, or fibrosis stage, you may need a multidisciplinary care team—a group of specialists working together to address every angle of your metabolic health [2][3].

Potential Members of Your MASH Care Team

A “whole-person” approach to MASH may involve several key roles:

  • Primary Care Provider: Often the coordinator for low-risk patients, handling overall metabolic health and arranging referrals when needed.
  • Hepatologist or Gastroenterologist: This is your liver specialist. They are responsible for confirming your diagnosis, staging your fibrosis (scarring), and deciding if you are a candidate for MASH-specific medications [1][4].
  • Endocrinologist: If you have difficult-to-control type 2 diabetes or severe insulin resistance, an endocrinologist helps optimize your blood sugar and hormone levels [1][5].
  • Cardiologist: Referral to a cardiologist is based on actual cardiovascular disease or high risk; they ensure your heart and arteries are protected by managing blood pressure and cholesterol [6][7].
  • Specialized Dietitian: A dietitian provides a personalized nutrition plan, often focusing on a Mediterranean-style diet, to help you achieve the weight loss necessary to heal the liver [1][8].
  • Obesity Medicine Specialist: If lifestyle changes alone aren’t enough, these specialists can coordinate weight-loss medications or referrals for bariatric surgery [9][1].

Preparing for Your First Specialist Visit

Your first consultation with a hepatologist is a critical “baseline” meeting. To get the most out of it, you should arrive with a clear picture of your metabolic history. This allows the specialist to focus on your future care rather than hunting for old data [10].

The Essential Checklist

Collect and bring the following records to your appointment (or ask your primary clinician to coordinate sending the records):

  • Liver Enzyme History: A record of your ALT and AST levels over the last year or two. Changes in these numbers over time are more telling than a single result [1].
  • Metabolic Labs: Your most recent HbA1c (blood sugar), lipid panel (cholesterol and triglycerides), platelet counts, bilirubin, albumin, INR, and creatinine [11][12].
  • Imaging and Reports: Don’t just bring the summary; bring the actual reports from any ultrasounds, CT scans, or FibroScans you have had [13][14].
  • Medication and Supplement List: Write down every prescription, over-the-counter medicine, and herbal supplement you take. Some “natural” supplements can actually stress the liver, and your doctor needs to see them all [1][12].

Auditing Your Care

As you build your team, focus your questions on how they assess risk and coordinate care. Ask about how the clinician stages fibrosis, follows current guidelines, evaluates medication eligibility, and communicates with your other providers. A provider who explains these steps clearly is demonstrating a commitment to comprehensive, evidence-based care [1][15].

Common questions in this guide

Who might be part of my MASH care team?
A primary care clinician may coordinate care, especially for lower-risk MASH. Depending on your liver scarring, diabetes control, heart risk, and weight-management needs, care may also involve a hepatologist or gastroenterologist, endocrinologist, cardiologist, dietitian, or obesity medicine specialist. The exact team is individualized.
What should I bring to my first MASH specialist appointment?
Bring records of your ALT and AST results from the past year or two, recent blood tests, and the actual reports from any ultrasound, CT scan, or FibroScan. Also bring a complete list of prescription and over-the-counter medicines, vitamins, and herbal supplements. Your primary clinician can help send records if needed.
Why are ALT and AST trends important in MASH?
Comparing ALT and AST results over time can provide more context than a single result. Your specialist reviews these trends along with other blood tests, imaging, and the degree of liver scarring to assess your health and plan monitoring or treatment.
Can my primary care clinician manage MASH, or do I need a specialist?
Many people with lower-risk MASH can be managed by primary care with targeted referrals. A liver specialist or additional team members may be needed when liver scarring is more advanced, diabetes is difficult to control, or other metabolic or cardiovascular concerns require coordinated care.
Should I tell my MASH doctor about vitamins and herbal supplements?
Yes. Include every prescription, over-the-counter medicine, vitamin, and herbal supplement because some supplements can stress the liver or affect your care. A complete list helps your clinician review treatment safety.
What should I ask about MASH treatment and care coordination?
Ask how liver scarring will be staged, which guidelines guide medication eligibility, what tests will monitor treatment safety and response, and how your providers will share updates. You can also ask whether a dietitian with experience in metabolic liver disease would be helpful.

Questions For You

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How do you stage fibrosis, and what current guidelines do you follow for evaluating medication eligibility?
  2. 2.What specific tests will assess my treatment safety and response, and what timeframe is clinically meaningful?
  3. 3.How will our team coordinate between you and my other doctors, like my primary care physician or endocrinologist?
  4. 4.Based on my fibrosis stage, do I need to see a specialist, or can my primary care doctor lead my management?
  5. 5.Can you recommend a specialized dietitian who has experience specifically with metabolic liver disease?

References

References (15)
  1. 1

    EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).

    , ,

    Journal of hepatology 2024; (81(3)):492-542 doi:10.1016/j.jhep.2024.04.031.

    PMID: 38851997
  2. 2

    Incorporating fatty liver disease in multidisciplinary care and novel clinical trial designs for patients with metabolic diseases.

    Eslam M, Ahmed A, Després JP, et al.

    The lancet. Gastroenterology & hepatology 2021; (6(9)):743-753 doi:10.1016/S2468-1253(21)00132-1.

    PMID: 34265276
  3. 3

    Metabolic Dysfunction-Associated Steatotic Liver Disease and Obesity: Pathogenesis, Diagnostics, Risk Stratification, and Therapeutic Approach.

    Kim BK

    The Kaohsiung journal of medical sciences 2026; e70227 doi:10.1002/kjm2.70227.

    PMID: 42028921
  4. 4

    Metabolic dysfunction-associated steatotic liver disease: A primer for primary care NPs.

    Casler K, Chaney A

    The Nurse practitioner 2026; (51(9)):20-30 doi:10.1097/01.NPR.0000000000000471.

    PMID: 42638316
  5. 5

    Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association.

    Cusi K, Abdelmalek MF, Apovian CM, et al.

    Diabetes care 2025; (48(7)):1057-1082 doi:10.2337/dci24-0094.

    PMID: 40434108
  6. 6

    Metabolic dysfunction-associated steatotic liver disease as a cardiovascular risk factor.

    Platek AE, Szymanska A

    Clinical and experimental hepatology 2023; (9(3)):187-192 doi:10.5114/ceh.2023.130744.

    PMID: 37790680
  7. 7

    A Gastroenterologist's Approach to Improving Metabolic Health in MASLD.

    Abdulrazzak E, Alabdul Razzak I, Noureddin M, Trivedi HD

    Journal of clinical gastroenterology 2025; (59(8)):713-724 doi:10.1097/MCG.0000000000002210.

    PMID: 40549660
  8. 8

    Diet and Lifestyle Interventions in Metabolic Dysfunction-Associated Fatty Liver Disease: A Comprehensive Review.

    Sheikh MY, Younus MF, Shergill A, Hasan MN

    International journal of molecular sciences 2025; (26(19)) doi:10.3390/ijms26199625.

    PMID: 41096891
  9. 9

    Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study.

    Schwartz AW, Park EY, Ilagan-Ying YC, et al.

    World journal of hepatology 2026; (18(1)):113753 doi:10.4254/wjh.v18.i1.113753.

    PMID: 41640960
  10. 10

    Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Diagnostic Pathways, Noninvasive Fibrosis Assessment, and Therapeutic Strategies.

    Bazan A, Plichta O, Radzinska N

    Cureus 2026; (18(5)):e108965 doi:10.7759/cureus.108965.

    PMID: 42306363
  11. 11

    Risk stratification of MASLD/MASH in type 2 diabetes: a pragmatic endocrinology outpatient pathway.

    Cai Y, Zeng F, Liu C

    Frontiers in endocrinology 2026; (17()):1922533 doi:10.3389/fendo.2026.1922533.

    PMID: 42597408
  12. 12

    Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions.

    Lin H, Wang H, Yang K, et al.

    Clinical and molecular hepatology 2026; (32(Suppl)):e2026.0398 doi:10.3350/cmh.2026.0398.

    PMID: 42669412
  13. 13

    Evidence-Based Clinical Practice Guidelines for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) 2026.

    Akuta N, Kogiso T, Ikejima K, et al.

    Hepatology research : the official journal of the Japan Society of Hepatology 2026; (56(6)):887-902 doi:10.1111/hepr.70188.

    PMID: 42118685
  14. 14

    Management strategies for metabolic dysfunction-associated steatotic liver disease (MASLD).

    Alkhouri N, Noureddin M

    The American journal of managed care 2024; (30(9 Suppl)):S159-S174 doi:10.37765/ajmc.2024.89635.

    PMID: 39513734
  15. 15

    Updated Global Consensus Recommendations for Risk Stratification, Treatment Initiation, and Response Monitoring in Metabolic Dysfunction-Associated Steatotic Liver Disease.

    Younossi ZM, Kalligeros M, Wong VW, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2026; (24(9)):2333-2347 doi:10.1016/j.cgh.2026.03.030.

    PMID: 41950980

This page is for informational purposes only and does not constitute medical advice about your MASH care. Your clinician should determine which referrals, tests, and treatments are appropriate for your fibrosis stage and overall health.