MASLD/MASH

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is a condition in which excess fat builds up in the liver due to metabolic dysfunction. It affects an estimated one in three adults in the United States and often develops without noticeable symptoms.

MASLD is associated with conditions such as obesity, insulin resistance, high cholesterol, and high blood pressure. Although it may remain stable for many people, it can progress in some cases.

When excess liver fat is accompanied by inflammation and damage to liver cells, the condition is called metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH). Over time, MASH can lead to fibrosis (liver scarring), cirrhosis, and an increased risk of liver cancer.

Symptoms

MASLD and MASH often cause no noticeable symptoms, particularly in the early stages. Many people discover they have fatty liver disease through routine blood tests or imaging performed for another reason.

When symptoms do occur, they may include fatigue, weakness, or discomfort in the upper right side of the abdomen. Because symptoms may not appear until the disease has progressed, understanding your risk factors and seeking appropriate evaluation are important.

Risk Factors

MASLD is closely linked to metabolic health. Risk factors include:

• Obesity or excess abdominal weight: Fat stored around the midsection is associated with increased fat accumulation in the liver. However, MASLD can also affect people who are not overweight.
• Type 2 diabetes or insulin resistance: These are among the strongest risk factors because they affect how the body processes sugar and fat.
• High cholesterol or triglycerides: Elevated blood lipids can contribute to liver fat accumulation.
• High blood pressure: Hypertension often occurs alongside other metabolic risk factors associated with MASLD.
• Sedentary lifestyle and dietary habits: Limited physical activity and diets high in processed foods, refined carbohydrates, and added sugars can contribute to the metabolic dysfunction underlying the disease.

Having one or more risk factors does not necessarily mean you have MASLD. A healthcare provider can help determine whether further evaluation is appropriate.

Diagnosis

Because MASLD often develops without symptoms, it may be identified during routine blood tests or imaging studies. Your gastroenterologist may recommend additional testing to evaluate liver fat and determine whether liver damage or scarring is present.

A FibroScan is a noninvasive test that measures liver stiffness and estimates liver fat. Depending on your medical history and initial findings, other blood tests, imaging studies, or diagnostic procedures may also be recommended.

Early evaluation can help identify the stage of the disease and guide an appropriate management plan.

Treatment

Treatment for MASLD and MASH depends on the severity of the condition, the presence of liver scarring, and your overall metabolic health. The primary goals are to reduce liver fat, address contributing health conditions, and prevent further liver damage.

Lifestyle changes and weight management
For many patients, lifestyle changes are the foundation of treatment. Losing approximately 5-10% of body weight, when medically appropriate, can improve liver health. Gradual, sustainable weight loss is preferable to crash dieting.

Healthy eating
A balanced, Mediterranean-style eating pattern that emphasizes vegetables, whole grains, lean proteins, and healthy fats may support liver health. Limiting added sugars, refined carbohydrates, and highly processed foods is also important.

Regular physical activity
Both aerobic exercise and resistance training can improve insulin sensitivity and reduce liver fat, even without significant weight loss. Consistent activity, including brisk walking several days a week, can be beneficial.

Managing related health conditions
Controlling blood sugar, cholesterol, and blood pressure can help reduce the metabolic factors contributing to liver disease. Your healthcare provider may recommend lifestyle changes, medication, or both.

Medication when appropriate
Additional treatment options are available for certain patients with MASH and liver fibrosis. Resmetirom (Rezdiffra) received FDA approval in 2024 for eligible adults with noncirrhotic MASH and moderate to advanced liver fibrosis. Other medications used for conditions such as Type 2 diabetes and obesity may also be considered in appropriate patients. Your gastroenterologist can help determine which treatments may be suitable for you.

Protecting your liver
Alcohol can contribute to liver damage, and patients with MASLD should discuss alcohol use with their healthcare provider. Certain supplements and over-the-counter medications can also affect the liver, so let your care team know about everything you take.

If you have the above risk factors and experience the above symptoms, please connect with one of our specialists to protect your health.