GLP-1 receptor agonists linked to lower liver fat and enzymes in MASLD, with histology unproven

The edition in brief

A meta-analysis of nine studies and 795 adults with MASLD or MASH found GLP-1 receptor agonists associated with lower liver fat (mean difference −3.17), body weight (−4.7), ALT (−15 U/L), AST (−10 U/L) and HbA1c (−0.78%), with more nausea and vomiting but no increase in serious adverse events; fibrosis and liver outcomes were not established. In the PIONIR crossover trial, 29 first-degree relatives of people with Crohn's disease who had persistently raised faecal calprotectin but no diagnostic endoscopic disease followed a structured diet or their usual diet for 8 weeks each; calprotectin halved in 71% on the diet against 27% on usual diet (RR 2.68). A multinational cohort of 679 outpatients with cirrhosis found that stool microbiome profiles added to clinical prediction of 90-day hospitalisation (AUC 0.84 against 0.79). The pearl covers what to do when an asymptomatic relative has a raised calprotectin.