Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

What is metabolic dysfunction-associated steatotic liver disease?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a group of liver diseases that happen when your body stores lots of fat in your liver (steatotic (fatty) liver disease (SLD). Over time, this fat in your liver can cause inflammation in your liver (hepatitis). Until recently, MASLD was known as nonalcoholic fatty liver disease (NAFLD.)

MASLD is one of the most common forms of chronic liver disease. Having obesity or Type 2 diabetes are common causes of MASLD. Given the rising rates of obesity and Type 2 diabetes, experts estimate more than 30% of people worldwide have this condition. Without treatment, MASLD can cause more serious liver diseases. Early diagnosis and treatment can keep MASLD from getting worse.

What are the symptoms of metabolic dysfunction-associated steatotic liver disease?

MASLD develops over several years. You can have it without having symptoms. You may not notice changes in your body unless you develop MASH (metabolic dysfunction-associated steatohepatitis).

MASH causes cirrhosis or severe liver fibrosis. Liver fibrosis is bands of scar tissue in your liver. Some people with MASH have symptoms like:

• An ache in your upper right abdomen, where your liver is
• Extreme fatigue and weakness
• Loss of appetite
• Swollen belly
• Unexpected weight loss
• Yellowing of your skin and eyes (scleral icterus)

What causes MASLD?

You may develop MASLD if you have metabolic dysfunction. This is a group of conditions that affect your metabolism. Your metabolism changes food into energy. Conditions that may lead to MASLD are:

• Dyslipidemia. This is high levels of lipids. Lipids are fatty or waxy substances that your body makes. Cholesterol is an example of a lipid in your blood.
• Having obesity. Obesity is when your body mass index (BMI) is 30 or higher. People who carry extra weight in their belly have an increased risk of MASLD.
• Insulin resistance. Insulin is a hormone that manages blood glucose (sugar levels). Insulin resistance happens when cells in your muscles, fat and liver don’t respond to insulin as they should.
• Type 2 diabetes. This is a chronic (long-term) condition that happens when you have high blood sugar (hyperglycemia).

Researchers have also found several genetic variations that increase MASLD risk.

What are the complications of metabolic dysfunction-associated steatotic liver disease?

Some people with MASLD may develop MASH. The condition can lead to more serious forms of MASH, including:

• MASH with liver fibrosis. Fibrosis is bands of scar tissue in your liver. Fibrosis happens when your liver tries to repair and replace damaged cells.
• MASH-related cirrhosis. This is scarring that damages your liver.
• Hepatocellular carcinoma. This is a type of liver cancer that can be caused by MASH.

MASLD may also increase your risk of developing serious conditions like:

• Cancer, including breast cancer and colorectal (colon cancer)
• Cardiovascular disease
• Diabetes in people who don’t already have diabetes

How do healthcare providers diagnose MASLD?

Healthcare providers will do certain blood tests and imaging tests (or a liver biopsy).

Blood tests

• A1C. This test measures the average amount of sugar (glucose) in your blood over the past two months.
• Complete blood count (CBC). This test measures the amounts and sizes of your blood cells.
• Comprehensive metabolic panel (CMP). This is a measurement of 14 substances in your blood like proteins and electrolytes.
• Lipid panel. This is a screening test for cardiovascular disease. It measures certain fat molecules in your blood.
• Liver function tests. These blood tests measure substances that your liver produces.

Imaging tests

Your healthcare provider may do imaging tests to look for signs of MASLD in your liver. Tests include:

• FibroScan®. This imaging test estimates the amount of fat and fibrosis in your liver.
• Magnetic resonance elastography and proton density fat fraction (MRE-PDFF). This test measures the percentage of fat and fibrosis in your liver.

Biopsy

Occasionally, your provider may perform a liver biopsy. They may do this if they think something other than MASLD causes your symptoms. They may also do a liver biopsy as a follow-up to imaging tests like FibroScan.

How is metabolic dysfunction-associated steatotic liver disease treated?

Treatment for MASLD usually starts with weight loss. Your healthcare provider will also treat conditions like diabetes, high cholesterol and high blood pressure, which cause MASLD.

Losing weight makes a difference in your liver health. Reducing excess fat in your liver helps with inflammation that leads to cirrhosis. Your provider may recommend meal plans like the Mediterranean diet or the DASH diet.

Doing moderate activity 30 minutes a day for three days a week supports weight loss. Your provider may recommend you lose 10% or more of your body weight. But even losing 3% to 5% of your weight can make a difference.

Weight loss medication

Your healthcare provider may recommend weight loss medications like GLP-1 agonists if you have diabetes and/or obesity. These medications help lower your blood sugar and help you lose weight. Weight loss medications may include:

• Semaglutide (Ozempic® or Wegovy®)
• Liraglutide (Victoza® or Saxenda®)
• Tirzapetide (Mounjaro® or Zepbound®)

Bariatric surgery

Your provider may discuss bariatric surgery with you. Bariatric surgery to support weight loss may reverse MASLD that’s diagnosed before you develop cirrhosis.

Can you reverse MASLD?

Yes, but that depends on your situation. In general, treatment can reverse MASLD unless you have MASH-related cirrhosis.

Receiving a diagnosis early on can help keep MASLD from doing a lot of damage to your liver. Taking steps, like losing weight, may reverse the impact MASLD has on your liver. But your situation depends on your overall health. Ask your healthcare provider whether losing weight can reverse this condition.

Can MASLD be prevented?

This condition often affects people who have obesity or Type 2 diabetes. You may not be able to prevent those conditions from happening. But it’s possible that early diagnosis and lifestyle changes may prevent MASLD.

If you have obesity or Type 2 diabetes, your healthcare provider may recommend blood and imaging tests to screen for signs of this condition. Caught early on, lifestyle changes could reduce your risk.

What’s the MASLD life expectancy?

Research shows having MASLD can affect how long you’ll live compared with people who don’t have it. For example, one study found the life expectancy for people with MASLD was about 2.8 years lower than the life expectancy for people who didn’t have the disease.

Many things affect how long you’ll live with MASLD. Your situation may be different from others. Your healthcare provider is your best source of information about what you can expect.

How do I take care of myself?

You can take care of yourself by working with healthcare providers to manage the conditions that lead to MASLD, like having overweight, having obesity and Type 2 diabetes. Losing weight and being active can help slow and possibly reverse liver damage. Here are some other suggestions:

• Keep track of your overall health. MASLD increases your risk of diabetes, heart disease and certain kinds of cancer. Ask your primary care provider about screening tests and ways to reduce your risk.
• Practice good liver health hygiene. Stop smoking and drinking beverages that contain alcohol. Smoking and drinking alcohol puts stress on your liver. Ask your provider about vaccinations for hepatitis A and hepatitis B.
• Stay the course. It takes time to lose weight. You may see progress one pound at a time. It also takes commitment to stay with regular activity. Talk to your provider if you start to lose steam on our weight loss journey.

When should I see my healthcare provider?

Contact your provider if you notice changes in your body like being more tired than usual or pain in your upper right abdomen. These changes could mean you’re developing MASH, a serious form of fatty liver disease that can lead to cirrhosis and hepatocellular cancer.

Does alcohol use cause MASLD?

No, it doesn’t. Until recently, MASLD was called nonalcoholic fatty liver disease (NAFLD) because you could develop this condition even though you don’t drink a lot of beverages containing alcohol.

That said, people with MASLD who drink beverages that contain alcohol are likely to develop cirrhosis much faster than usual. That’s why healthcare providers typically tell people who have MASLD to avoid beverages that contain alcohol.