If you’ve ever heard of Fatty Liver Disease, Non-Alcoholic Fatty Liver Disease (NAFLD), Non-Alcoholic Cirrhosis, Non-Alcoholic Steatohepatitis (NASH), Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) or Metabolic Dysfunction-Associated Steatohepatitis (MASH), would you know they’re all basically the same?
Would you know over a third of people worldwide have it? Most importantly, would you know it’s treatable and potentially reversible?
The nomenclature (name) of the disease has changed to MASLD: Metabolic Dysfunction- Associated Steatotic Liver Disease, and here’s what you need to know now.
By any other name
Made up of several potentially confusing words that refuse to form a proper acronym, it would be easy for MASLD (pronounced “mazzled”) to be misinterpreted as an exotic and mysterious condition when it is anything but.
Metabolic Dysfunction-Associated describes where the problem begins, in the way our bodies break down the food we eat and use it as energy for all daily functions and activities. This process, called metabolism, can get disrupted, less often by rare genetic conditions in childhood than by typically preventable conditions in adulthood.
Metabolic syndrome, dyslipidemia (including high LDL cholesterol, low HDL cholesterol and high triglycerides), obesity, type 2 diabetes and insulin resistance are all types of metabolic dysfunction that contribute to MASLD. They all impact the way the body converts food into energy.
Steatotic simply means the buildup of fat in an organ, generally the liver. Liver Disease is the last, and perhaps the only self-explanatory part, of the name.
Seeing what’s beneath the MASLD mask is critically important, as it’s a very common condition worldwide and isn’t what comes to mind first when many think of liver disease. Much confusion may have come from the previous name Non-Alcoholic Cirrhosis. Cirrhosis is the term for scarring of the liver and is most often associated with heavy, long-term alcohol use.
It is crucial to understand that MASLD is the most common chronic liver disease in the United States, 100 times more common than alcoholic cirrhosis. It’s important to permanently separate the two in your mind, to appreciate your true risk of developing MASLD.
Who has MASLD?
If you don’t know, you are in excellent company. One study found 96% of adults who had MASLD were unaware they had liver disease. Some estimates across the world state as many as 40% of adults have MASLD. Others indicate that of reporting countries, Europe ranks at the low end at 25% and South America at the high end at 44%.
Type 2 diabetes and MASLD are each a risk factor for the other; if you have one already, your chances of getting the other are much greater. About 70% of type 2 diabetics will develop MASLD. The prevalence of both diseases is increasing dramatically, even in children, as kids' obesity rates continue to climb. Experts estimate rates of MASLD have tripled in the last 20 years alone. At present, MASLD is the #2 cause of liver transplants in men, #1 in women.
Metabolic syndrome is a set-up for both type 2 diabetes and MASLD. Metabolic syndrome is a group of conditions or factors including increased waist/abdominal fat, high blood pressure, abnormal cholesterol or triglyceride levels (including lower HDL cholesterol) and high blood sugar. Having one of these doesn’t mean you have metabolic syndrome, and having only 3 out of 5 doesn’t mean you’re in the clear.
Along with increasing your risk of MASLD, metabolic syndrome can have complications of heart disease, type 2 diabetes and stroke. Up to a third of US adults have metabolic syndrome, and it may be easier now to see how it can dovetail into MASLD.
What are the symptoms?
MASLD may have no symptoms at all. For those whose MASLD progresses to liver inflammation (MASH or Metabolic-Dysfunction Associated Steatohepatitis), symptoms may include severe fatigue, weakness, right upper abdominal pain or tenderness, weight loss, yellowing of the eyes or skin, persistent itching and spider veins.
For the relative few who will go on from MASH to develop cirrhosis, symptoms include confusion, muscle wasting, fluid retention and internal bleeding.
Getting diagnosed with MASLD
Although routine bloodwork may be normal even with MASLD, elevated liver enzymes are a clue. Other blood tests can be used to further rule out the possibility of other conditions.
A quick, non-invasive ultrasound can painlessly evaluate the liver with sound waves to determine damage type and amount. Changes in size, shape and blood flow can be seen on the ultrasound and help your practitioner make a diagnosis. A CT or MRI could also be used. This newer technology is preferred over a liver biopsy by most patients and practitioners in many cases.
As MASLD has been poorly understood by many, including those who have it, it’s not unusual to be diagnosed after decades of damage have been done. This, combined with the rising number of children and young adults at elevated risk for MASLD, makes it more important than ever to understand the risks and act to reduce them.
Now that you know
One of the best ways to make life better with MASLD is to maintain a healthy body weight. As the liver is relieved from processing extra calories and having to store them within itself as fat, it can instead have the opportunity to heal. Although drinking alcohol is not the reason for MASLD, resting the liver from processing alcohol aids its overall function.
Control any controllable risk factors to the best of your ability. This includes managing blood lipid levels and diabetes as well as exercising to control blood pressure and blood sugars. These go a long way to decrease the added risks and complications of metabolic syndrome, including MASLD.
Even if you learn MASLD has progressed to the more serious MASH, researchers have seen some regression of liver scarring is possible if caught early and treated with an improved diet and healthier lifestyle.
References
Alqahtani, S. A., Paik, J. M., Biswas, R., Arshad, T., Henry, L., & Younossi, Z. M. (2021). Poor Awareness of Liver Disease Among Adults With NAFLD in the United States. Hepatology Communications, 5(11), 1833. https://doi.org/10.1002/hep4.1765
Hosseini Shabanan S, Martins VF, Wolfson T, Weeks JT, Ceriani L, Behling C, Chernyak V, El Kaffas A, Borhani AA, Han A, Wang K, Fowler KJ, Sirlin CB. MASLD: What We Have Learned and Where We Need to Go-A Call to Action. Radiographics. 2024 Nov;44(11):e240048. doi: 10.1148/rg.240048. PMID: 39418184; PMCID: PMC11580021. https://pubs.rsna.org/doi/full/10.1148/rg.240048
Leith, D., Lin, Y. Y., & Brennan, P. (2024). Metabolic Dysfunction-associated Steatotic Liver Disease and Type 2 Diabetes: A Deadly Synergy. TouchREVIEWS in Endocrinology, 20(2), 5. https://doi.org/10.17925/EE.2024.20.2.2
Machado, M. V. (2023). MASLD treatment—A shift in the paradigm is imminent. Frontiers in Medicine, 10, 1316284. https://doi.org/10.3389/fmed.2023.1316284
Sanchez, L. O., Chen, Y., Lassailly, G., & Qi, X. (2023). Exploring the links between types 2 diabetes and liver‐related complications: A comprehensive review. United European Gastroenterology Journal, 12(2), 240. https://doi.org/10.1002/ueg2.12508 Assessed and Endorsed by the MedReport Medical Review Board