Expert panel perspectives on improving the diagnosis and management of metabolic dysfunction-associated steatohepatitis in Denmark

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide. Progression to metabolic dysfunction-associated steatohepatitis (MASH) can result in fibrosis, cirrhosis, and increased mortality. MASLD and MASH are often under-diagnosed due to their asymptomatic nature, limited awareness, and stigma associated with both liver disease and increased body weight, often resulting in delayed diagnosis. Unclear referral pathways from general practice to specialists and dietitians are often delayed, limiting timely and coordinated care. Given the growing concern regarding MASH and its urgent challenges, the first national, structured, multidisciplinary expert group in Denmark was convened to identify recommendations by capturing a broad, practice-oriented perspective. Methods: Eleven experts with overlapping roles participated, including nine with scientific and clinical expertise in obesity, diabetes, and gastroenterology/hepatology, two from general practice, a dietitian, and three representing patient associations, ensuring both clinical and patient perspectives. Results: The expert panel identified seven focus areas for improving MASH diagnosis and management in Denmark. Key challenges included late diagnosis, low awareness, and suboptimal referral pathways. Moreover, the panel highlighted the need for standardised referral processes, interdisciplinary collaboration, and increased awareness in primary care to enable timely detection and coordinated care. The framework provides a practice-oriented foundation for national strategies, supporting structured patient pathways, coherent management, and future implementation initiatives. Conclusions: Taken together, this publication can serve as a reference for general practitioners, medical specialists, dietitians, professional societies, and healthcare authorities, to support the development of structured, sustainable pathways for MASH care in Denmark.