What is metabolic dysfunction-associated steatotic liver disease (MASLD)?

Fatty liver disease means that you have extra fat inside your liver. This extra fat keeps your liver from doing a good job of removing toxins from your blood. People who drink too much alcohol may have fat in their liver. When the fatty liver does not come from drinking too much alcohol, it is called metabolic dysfunction-associated steatotic liver disease. 

There are 2 types:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) -  When you have fat in your liver, but your liver is not damaged.

  • Metabolic dysfunction-associated steato hepatitis (MASH) - When you have fat in your liver AND also signs of inflammation and liver cell damage.

What causes MASLD?

Healthcare providers don’t know the exact cause. Certain health conditions are closely linked to MASLD. These include obesity, insulin resistance, metabolic syndrome, type 2 diabetes, high cholesterol, and high triglycerides. These conditions may help lead to extra fat in the liver or fatty liver disease.

Who is at risk for MASLD?

Children and young adults can get this disease. But it is most common in middle age. Risk factors for it are:

  • Being overweight or obese, especially having too much belly fat (central obesity)

  • Having high blood fat levels (either triglycerides or LDL cholesterol)

  • Having type 2 diabetes or prediabetes

  • Having high blood pressure

When these risk factors happen together, they cause a health problem called metabolic syndrome. People with metabolic syndrome often have fatty liver. They also are more likely to have heart disease. Other conditions that may raise your risk include polycystic ovary syndrome, sleep apnea, and hypothyroidism. 

What are the symptoms of MASLD?

MASLD is sometimes called a silent liver disease. This is because it can happen without causing any symptoms. Most people with MASLD live with fat in their liver without getting liver damage. A few people who have fat in their liver develop metabolic dysfunction-associated steatohepatitis (MASH).

If you have MASH, you may have symptoms. But it could take years for them to show up. Sometimes liver damage from MASH causes long-term scarring and hardening of your liver. This is called cirrhosis. It also increases risk for liver cancer. Symptoms from MASH may include:

  • Severe tiredness (fatigue)

  • Pain in the right upper belly (abdomen)

  • Weakness

  • Weight loss

  • Yellowing of the skin or eyes (jaundice)

  • Spiderlike blood vessels on the skin

  • Long-lasting itching

MASH that turns into cirrhosis could cause these symptoms:

  • Extra fluid buildup (fluid retention)

  • Internal bleeding

  • Muscle wasting

  • Confusion

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is MASLD diagnosed?

MASLD can happen without causing any symptoms. It’s often diagnosed when you have routine blood tests to check your liver. Your healthcare provider may think you have it if your test results are abnormal. This is especially true if you are obese or have diabetes. 

Your healthcare provider may use these tests to help make a diagnosis:

  • Imaging tests. Ultrasound, CT scan, or MRI may show fat deposits in your liver.

  • Blood test. A special blood test can check how diseased your liver is.

  • Liver biopsy. The provider puts a long needle through your skin into your liver. The needle removes a small piece of liver tissue. The tissue can be looked at under a microscope.

Based on the test results, your healthcare provider will make the following diagnosis:

  • You have MASLD if you have fat but no inflammation or tissue damage.

  • You have MASH if you have fat, inflammation, and liver damage.

  • You may be developing cirrhosis if you have a type of scar tissue in your liver called fibrosis.

How is MASLD treated?

If you have MASLD without any other health problems, you don’t need any special treatment. But making some lifestyle changes can control or reverse the fat buildup in your liver. These may include:

  • Losing weight

  • Lowering your cholesterol and triglycerides

  • Controlling your diabetes, if needed

  • Not drinking alcohol

If you have MASH, no medicine can fully reverse the fat buildup in your liver. Sometimes the liver damage stops or even reverses itself. But for other people, the disease keeps getting worse. If you have MASH, it’s important to control any conditions that may help cause the disease. Treatments and lifestyle changes may include:

  • Losing weight

  • Exercising more

  • Taking medicine to lower cholesterol or triglycerides

  • Taking medicine to lower blood pressure

  • Taking medicine to control diabetes

  • Limiting over-the-counter medicines

  • Not drinking alcohol. No amount of alcohol is known to be fully safe once you have NASH.

  • Eating a diet low in fat and simple carbohydrates

  • Seeing a liver specialist

Your provider may advise certain medicines if you have MASH. These include vitamin E in people without diabetes or heart disease. And they include pioglitazone, a diabetes medicine for people with or without diabetes. But these have side effects, so talk about them with your healthcare provider. Other medicines, including certain herbal supplements, are being looked into. Treating the underlying conditions is the absolute most important thing and is more effective than any medicine.

What are possible complications of MASLD?

The main complication is that MASH can become cirrhosis. Cirrhosis means lasting (permanent) scarring and hardening of the liver. People with cirrhosis may develop liver failure and need a liver transplant. MASH may also progress to liver cancer. Talk with your healthcare provider about any concerns you may have.  

How do I manage MASLD?

If you have MASLD, learn as much as you can about your condition. Work closely with your healthcare team. Many medicines can harm your liver. So always tell all your healthcare providers about any medicines you are taking. These include over-the-counter medicines, dietary supplements, herbs, and vitamins.

  • Other ways to manage the disease are:

  • Staying at a healthy weight

  • Eating a balanced diet

  • Getting regular exercise

  • Not drinking alcohol

Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.

When should I call my healthcare provider?

Call your healthcare provider if you have any symptoms that mean MASLD is getting worse. These are:

  • Severe tiredness (fatigue)

  • Loss of appetite

  • Weight loss

  • Weakness

  • Extra fluid buildup (fluid retention)

  • Bleeding

Marshall Internal Medicine

A provider-based department of Cabell Huntington Hospital
Erma Ora Byrd Clinical Center
1249 15th Street
2nd & 3rd Floor
Huntington, WV 25701
Phone: 304.691.1000

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