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Introduction Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a global epidemic and leading indication for liver transplantation. MASLD frequently co-exists with cardiometabolic risk factors but, despite this, hepatology services are often under-resourced and ill-equipped to provide the multidisciplinary service needed to address this population’s demands. Furthermore, with promising phase 3 clinical trials of novel therapeutics, a new wave of treatment options is on the horizon. We aimed to evaluate the metabolic phenotype of patients with MASLD-related advanced fibrosis at a tertiary hepatology centre to consider which patients may benefit from specific therapeutic options.Methods We retrospectively retrieved data for patients attending MASLD outpatient services during a 3-year period (May 2022-May 2025) using electronic health records. Data interrogated included demographics, survival, vital observations, investigations, and prescribed medications. Fibrosis stage was categorised into low risk of advanced fibrosis, F3, F4 and indeterminate. Fibrosis stage was determined on (1) Fibroscan with minimal inter-measurement variability (IQR <30%; low risk liver stiffness measurement (LSM) <8kPa, F3 = LSM 10–15kPa, F4 = LSM >15Pa), (2) MR elastography (low risk LSM <3.53kPa, F3 3.53–4.45kPa, F4 >4.45kPa) and (3) health record interrogation for radiological evidence of cirrhosis or liver biopsy.Results 1139 patients were seen in the MASLD service during the study period, of whom 53% (n=598) had advanced fibrosis; F3 (n=195) or F4 (n=403). 57% were male (n=339), median age was 65 years (range 17–92) and 44 patients died within the study period (7%). 92% were overweight or obese (n=552) and 22% met criteria for class III obesity, with BMI >40 kg/m2 (n=129). 72% had type 2 diabetes (T2DM), of whom 60% (261 patients) had poor glycaemic control (HbA1c ≥53mmol/mol). In patients with advanced liver fibrosis and a BMI classified as healthy or underweight, 79% had T2DM (n=31). Of those eligible for glucagon-like-peptide-1 (GLP-1RA) receptor agonist or combined GLP-1RA/gastric-inhibitory polypeptide (GIP) analogue therapy by current criteria, with T2DM and a BMI ≥35kg/m2, only 36% (n=67/188) had one of these medications prescribed.Discussion In our service, a high proportion of patients with MASLD-related advanced fibrosis have poorly controlled metabolic conditions, with an impact of cardiovascular and liver outcomes. This analysis highlights the need for enhanced and integrated access to incretin-based therapies in this cohort, as well as characterising a further group who may benefit from alternative, liver-directed therapies.References Sanyal AJ, Newsome PN, Kliers I, Østergaard LH, Long MT, Kjær MS, Cali AM, Bugianesi E, Rinella ME, Roden M, Ratziu V. Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. New England Journal of Medicine. 2025 Apr 30.Liu L, Wang F, Gracely EJ, Moore K, Melly S, Zhang F, Sato PY, Eisen HJ. Burden of uncontrolled hyperglycemia and its association with patients characteristics and socioeconomic status in Philadelphia, USA. Health Equity. 2020 Dec 1;4(1):525–32.