Austrian multisociety consensus on metabolic dysfunction-associated steatotic liver disease : Austrian Society of Gastroenterology and Hepatology (ÖGGH), Austrian Society of Diabetology (ÖDG), Austrian Society of Obesity (ÖAG)

Mattias Mandorfer^{1

2}, Georg Semmler^{3

4}, Elmar Aigner⁵, Alexander Bräuer⁶, Johanna Maria Brix^{7

8}, Martin Clodi⁹, Christian Datz¹⁰, Maria Effenberger¹¹, Daniel Moritz Felsenreich¹², Bernhard Ludvik^{7

8}, Andreas Maieron^{13

14}, Markus Peck-Radosavljevic¹⁵, Claudia Ress¹¹, Thomas-Matthias Scherzer¹⁶, Harald Sourij¹⁷, Lars Stechemesser⁵, Herbert Tilg¹¹, Michael Trauner³, Martin Wagner^{18

19

20}, Harald Hofer^{21

22}, Florian W Kiefer²³, Peter Fasching⁶, Michael Roden^{24

25

26}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. mattias.mandorfer@meduniwien.ac.at.
² Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria. mattias.mandorfer@meduniwien.ac.at.
³ Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
⁴ Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
⁵ First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁶ 5th Medical Department with Endocrinology, Rheumatology and Acute Geriatrics, Clinic Ottakring, Vienna Health Association, Vienna, Austria.
⁷ 1st Medical Department with Diabetology, Endocrinology and Nephrology, Clinic Landstraße, Vienna Health Association, Vienna, Austria.
⁸ Karl Landsteiner Institute for Obesity and Metabolic Disorders, Vienna, Austria.
⁹ Clinical Division of Internal Medicine, Saint John of God Hospital, Linz, Austria.
¹⁰ Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria.
¹¹ Division of Gastroenterology, Hepatology, Endocrinology and Metabolism, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
¹² Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
¹³ Karl Landsteiner University of Health Sciences, Krems, Austria.
¹⁴ Department of Internal Medicine 2, Gastroenterology & Hepatology, University Hospital St, Dunant-Platz 1, 3100, St. Pölten, Austria.
¹⁵ Innere Medizin und Gastroenterologie (IMuG), Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria.
¹⁶ Department of Medicine I-Gastroenterology and Hepatology, University Hospital Wiener Neustadt, Wiener Neustadt, Austria.
¹⁷ Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁹ Research Unit for Translational Nuclear Receptor Research, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
²⁰ BioTechMed, Graz, Austria.
²¹ Department of Internal Medicine I, Gastroenterology and Hepatology, Rheumatology, Endocrinology and Diabetology, Klinikum Wels-Grieskirchen, Wels, Austria.
²² Clinical Research Institute for Inflammation Medicine, Johannes Kepler University, Linz, Austria.
²³ Division of Endocrinology & Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
²⁴ Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.
²⁵ Leibniz Institute for Diabetes Research at Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Düsseldorf, Germany.
²⁶ German Center for Diabetes Research (DZD e. V.), München-Neuherberg, Germany.

PMID: 41107485
PMCID: PMC12534228
DOI: 10.1007/s00508-025-02617-4

Austrian multisociety consensus on metabolic dysfunction-associated steatotic liver disease : Austrian Society of Gastroenterology and Hepatology (ÖGGH), Austrian Society of Diabetology (ÖDG), Austrian Society of Obesity (ÖAG)

Mattias Mandorfer et al. Wien Klin Wochenschr. 2025 Oct.

. 2025 Oct;137(Suppl 10):307-319.

doi: 10.1007/s00508-025-02617-4. Epub 2025 Oct 17.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. mattias.mandorfer@meduniwien.ac.at.
² Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria. mattias.mandorfer@meduniwien.ac.at.
³ Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
⁴ Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
⁵ First Department of Medicine, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁶ 5th Medical Department with Endocrinology, Rheumatology and Acute Geriatrics, Clinic Ottakring, Vienna Health Association, Vienna, Austria.
⁷ 1st Medical Department with Diabetology, Endocrinology and Nephrology, Clinic Landstraße, Vienna Health Association, Vienna, Austria.
⁸ Karl Landsteiner Institute for Obesity and Metabolic Disorders, Vienna, Austria.
⁹ Clinical Division of Internal Medicine, Saint John of God Hospital, Linz, Austria.
¹⁰ Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria.
¹¹ Division of Gastroenterology, Hepatology, Endocrinology and Metabolism, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
¹² Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
¹³ Karl Landsteiner University of Health Sciences, Krems, Austria.
¹⁴ Department of Internal Medicine 2, Gastroenterology & Hepatology, University Hospital St, Dunant-Platz 1, 3100, St. Pölten, Austria.
¹⁵ Innere Medizin und Gastroenterologie (IMuG), Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria.
¹⁶ Department of Medicine I-Gastroenterology and Hepatology, University Hospital Wiener Neustadt, Wiener Neustadt, Austria.
¹⁷ Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
¹⁹ Research Unit for Translational Nuclear Receptor Research, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
²⁰ BioTechMed, Graz, Austria.
²¹ Department of Internal Medicine I, Gastroenterology and Hepatology, Rheumatology, Endocrinology and Diabetology, Klinikum Wels-Grieskirchen, Wels, Austria.
²² Clinical Research Institute for Inflammation Medicine, Johannes Kepler University, Linz, Austria.
²³ Division of Endocrinology & Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
²⁴ Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.
²⁵ Leibniz Institute for Diabetes Research at Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Düsseldorf, Germany.
²⁶ German Center for Diabetes Research (DZD e. V.), München-Neuherberg, Germany.

PMID: 41107485
PMCID: PMC12534228
DOI: 10.1007/s00508-025-02617-4

Abstract

This joint consensus document of the Austrian Societies of Gastroenterology and Hepatology (ÖGGH), Diabetology (ÖDG), and Obesity (ÖAG) is intended to provide practical guidance for the management of persons with metabolic dysfunction-associated steatotic liver disease (MASLD), including persons with combined metabolic dysfunction and alcohol-related steatotic liver disease (MetALD).

Keywords: MetALD; NAFLD; NASH; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis.

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Conflict of interest statement

Conflict of interest: M. Mandorfer received grant support from Echosens, served as a speaker and/or consultant and/or advisory board member for AbbVie, AstraZeneca, Echosens, Eli Lilly, Gilead, Ipsen, Takeda, and W. L. Gore & Associates, and received travel support from AbbVie and Gilead. G. Semmler received travel support from Amgen. E. Aigner served as speaker and/or advisory board member for Sanofi-Aventis, Gilead, Eli Lilly, Boehringer Ingelheim, Bayer, Falk Pharma, Amicus, Takeda, and Roche and received travel support from Sanofi-Aventis, Gilead, Eli Lilly, Boehringer, Bayer, Falk Pharma, Amicus, Takeda, and Roche. A. Bräuer served as speaker and/or consultant and/or advisory board member for Eli Lilly and Novo Nordisk and received travel support from Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. J. Maria Brix served as speaker and/or consultant and/or advisory board member for AstraZeneca, Dexcom, Boehringer Ingelheim, Eli Lilly, Medtronic, and Novo Nordisk. M. Effenberger served as a speaker and/or consultant and/or advisory board member for Ipsen and received travel support from Ipsen. A. Maieron served as speaker and/or consultant and/or advisory board member for Boehringer Ingelheim, Eli Lilly, MSD, and Madrigal. B. Ludvik received grant support from Boehringer-Ingelheim, Novo Nordisk, Madrigal, Eli Lilly, and Amgen and served as a speaker/advisor for AstraZeneca, Amgen, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. M. Peck-Radosavljevic served as speaker and/or advisory board member for AstraZeneca, BMS, Boehringer Ingelheim, Eli Lilly, Eisai, Falk, Gilead, Ipsen, Intercept-Advanz, Merz, MSD, Roche, Sanofi, Shionogi, and Sobi. L. Stechemesser served as speaker and/or consultant and/or advisory board member for Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. M. Trauner received grant support from Albireo, Alnylam, Cymabay, Falk Pharma, Genentech, Gilead, Intercept, MSD, Takeda and UltraGenyx; honoraria for consulting from AbbVie, Albireo, Agomab, Alfasigma, Boehringer Ingelheim, BiomX, Chemomab, Dexoligo Therapeutics, Falk Pharma, Genfit, Gilead, GSK, Hightide, Intercept, Ipsen, Janssen, Mirum, MSD, Novartis, Phenex, Pliant, Rectify, Regulus, ProQR Therapeutics, Siemens, and Shire; speaker fees from Albireo, Boehringer Ingelheim, BMS, Falk Foundation, Gilead, Ipsen, Intercept, Mirum, MSD, and Madrigal as well as travel support from AbbVie, Falk Foundation, Gilead, Jannsen, Intercept, and Ipsen. He is also co-inventor of patents on the medical use of 24-norursodeoxycholic acid (service inventions as employee) filed by the Medical University of Graz. H. Hofer served as a speaker and/or advisory board member for AbbVie, Falk Pharma, Gilead, Ipsen, Eli Lilly, Boehringer Ingelheim, and Madrigal, and received travel support from Abbvie, Falk Pharma, Gilead, Ipsen, Eli Lilly, Boehringer Ingelheim, and Madrigal. F.W. Kiefer served as speaker and/or consultant and/or advisory board member for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, and Sanofi Aventis. P. Fasching served as speaker and/or consultant and/or advisory board member for Boehringer Ingelheim, Eli Lilly, and Novo Nordisk and received travel support from Boehringer Ingelheim and Novo Nordisk. M. Roden received grant support for investigator-initiated research from Boehringer Ingelheim, Novo Nordisk, and Sanofi-Aventis to the German Diabetes Center (DDZ) and served as a speaker and/or consultant and/or advisory board member for AstraZeneca, Echosens, Eli Lilly, Madrigal, MSD, Novo Nordisk, Pfizer, Synlab, and Target RWE. M. Clodi, C. Datz, D. Moritz Felsenreich, C. Ress, T.-M. Scherzer, H. Sourij, M. Wagner, and H. Tilg have nothing to disclose. Ethical standards: For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

Figures

**Fig. 1**
Diagnosis and work-up of steatotic liver disease (SLD) and its sub-entities. *ALD* alcohol-related liver disease, *AUD* alcohol use disorder, *BIA* bioimpedance analysis, *BMI* body mass index, *CMRF* cardiometabolic risk factors, *DXA* dual-energy X‑ray absorptiometry, *ETG* ethyl glucuronide, *MASLD* metabolic dysfunction-associated steatotic liver disease, *MetALD* metabolic dysfunction and alcohol-related steatotic liver disease, *PEth* phosphatidylethanol, *SLD* steatotic liver disease

**Fig. 2**
Interpretation of VCTE, SWE, and ELF and resulting monitoring recommendations. Numbers in grey indicate cut-offs supported by less evidence. *cACLD* compensated advanced chronic liver disease, *ELF* Enhanced Liver Fibrosis test, *HCC* hepatocellular carcinoma, *LSM* liver stiffness measurement, *SWE* shear-wave elastography, *VCTE* vibration-controlled transient elastography

**Fig. 3**
Algorithm for risk assessment in individuals with MASLD/MetALD, applicable for case finding of fibrosis associated with SLD. ¹ Age-adjusted cut-off < 2 to rule out advanced fibrosis if age > 65 years. ² If a false positive result is suspected, repeat after 2–4 weeks. *ALD* alcohol-related liver disease, *ALT* alanine aminotransferase, *AST* aspartate aminotransferase, *cACLD* compensated advanced chronic liver disease, *CMRF* cardiometabolic risk factors, *ELF* Enhanced Liver Fibrosis test, *HCC* hepatocellular carcinoma, *LSM* liver stiffness measurement, *MASH* metabolic dysfunction-associated steatohepatitis, *MASLD* metabolic dysfunction-associated steatotic liver disease, *MetALD* steatotic liver disease with metabolic-dysfunction and alcohol-related components, *SLD* steatotic liver disease, *SWE* shear-wave elastography, *VCTE* vibration-controlled transient elastography

See this image and copyright information in PMC

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Austrian multisociety consensus on metabolic dysfunction-associated steatotic liver disease : Austrian Society of Gastroenterology and Hepatology (ÖGGH), Austrian Society of Diabetology (ÖDG), Austrian Society of Obesity (ÖAG)

Affiliations

Austrian multisociety consensus on metabolic dysfunction-associated steatotic liver disease : Austrian Society of Gastroenterology and Hepatology (ÖGGH), Austrian Society of Diabetology (ÖDG), Austrian Society of Obesity (ÖAG)

Authors

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Abstract

Conflict of interest statement

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