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Writer's pictureM.R. Grigsby
Oct 274 min read

Metabolic Dysfunction-associated Steatotic Liver Disease


Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is a chronic liver condition characterized by excessive fat accumulation in the liver. This name change, implemented in 2023, better reflects the disease's underlying metabolic nature and removes the stigma associated with the term "non-alcoholic."


Epidemiology


MASLD has become increasingly prevalent worldwide, affecting approximately 25% of the global adult population. The condition is particularly common in:


  • Individuals with obesity (up to 75% prevalence)

  • Type 2 diabetes patients (up to 70% prevalence)

  • People with metabolic syndrome


Pathophysiology


The development of MASLD involves multiple factors:


Primary Mechanisms

  1. Insulin resistance

  2. Lipid accumulation in hepatocytes

  3. Oxidative stress

  4. Inflammatory responses

  5. Mitochondrial dysfunction


Risk Factors

  • Obesity

  • Type 2 diabetes

  • Hypertension

  • Dyslipidemia

  • Metabolic syndrome

  • Genetic predisposition

  • Sedentary lifestyle


Clinical Presentation and Progression


Stages of Disease


  1. Simple Steatosis

    • Fat accumulation without significant inflammation

    • Generally reversible with lifestyle modifications

  2. Metabolic Dysfunction-associated Steatohepatitis (MASH)

    • Previously known as NASH

    • Inflammation and liver cell damage

    • May progress to fibrosis

  3. Advanced Fibrosis and Cirrhosis

    • Scarring of liver tissue

    • Potential development of hepatocellular carcinoma


Symptoms


Most patients are asymptomatic in early stages. When symptoms occur, they may include:

  • Fatigue

  • Right upper quadrant discomfort

  • Unexplained weight loss

  • In advanced cases: jaundice, ascites, and portal hypertension


Diagnosis




Non-invasive Assessment

  1. Blood Tests

    • Liver function tests

    • Lipid profile

    • Glucose levels

    • Markers of insulin resistance

  2. Imaging Studies

    • Ultrasound

    • Fibroscan (transient elastography)

    • MRI-PDFF (proton density fat fraction)

    • MR elastography


Liver Biopsy

  • Gold standard for diagnosis

  • Indicates disease severity and progression

  • Not required for all patients


Management


Lifestyle Modifications


  1. Weight Loss

    • Target: 7-10% body weight reduction

    • Gradual weight loss through caloric restriction

    • Regular physical activity (150+ minutes/week)

  2. Dietary Changes

    • Mediterranean diet pattern

    • Reduced processed food intake

    • Limited fructose consumption

    • Adequate protein intake


Medical Management


  1. Treatment of Metabolic Comorbidities

    • Diabetes management

    • Blood pressure control

    • Lipid-lowering therapy

  2. Emerging Therapies

    • GLP-1 receptor agonists

    • PPARα/δ agonists

    • FXR agonists

    • Thyroid hormone receptor-β agonists


Prevention


Key preventive strategies include:


  • Maintaining healthy body weight

  • Regular physical activity

  • Balanced nutrition

  • Management of metabolic conditions

  • Regular health screenings


Monitoring and Follow-up


  • Regular liver function tests

  • Periodic imaging studies

  • Assessment of cardiovascular risk

  • Screening for liver cancer in cirrhotic patients

  • Management of complications in advanced disease


Prognosis


The prognosis varies depending on:


  • Disease stage at diagnosis

  • Presence of comorbidities

  • Response to interventions

  • Compliance with lifestyle modifications


Early identification and intervention generally lead to better outcomes.


Future Directions


Research continues in:


  • Novel therapeutic targets

  • Biomarker development

  • Non-invasive diagnostic tools

  • Personalized treatment approaches

  • Prevention strategies

Conclusion


MASLD represents a significant global health challenge that requires a comprehensive approach to management. Early identification, lifestyle modifications, and appropriate medical intervention are crucial for optimal outcomes. Ongoing research continues to enhance our understanding and treatment options for this increasingly common condition.


Managing fatty liver includes the following approaches:


1. Maintain a healthy weight

2. Avoid a high-fat diet

3. Keep your blood sugar controlled

4. Avoid alcohol

5. Do not use medications that are contraindicated for use with liver disease, such as Tylenol (acetaminophen)

6. Minimize your consumption of foods that contain preservatives, dyes, and artificial ingredients.

7. Try to eat a diet that is rich in health-promoting antioxidants, such as vitamin E and vitamin C


There are several herbs associated with improved liver health. Milk thistle, turmeric, and burdock may have detoxifying effects. Herbs have not been proven to work as effective treatments for MASLD, but experts suggest that they may have potential in treating this disease.11


Finding out you have liver disease can come as a shock, particularly if you do not drink heavily. Remember that there are strategies to control your disease, even if you have MASH or MASLD. Your general health will certainly improve when you follow the guidelines for controlling your liver disease since the strategies—weight loss, eating natural, healthful foods, and blood sugar control—can help prevent many other problems in addition to MASLD and MASH.

 

References:


  1. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts of NAFLD & NASH.

  2. Paschos P, Paletas K. Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia.

  3. Rinella ME, Lazarus JV, Ratziu V, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2023;101133. doi:10.1016/j.aohep.2023.101133

  4. Perumpail BJ, Khan MA, Yoo ER, Cholankeril G, Kim D, Ahmed A. Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(47):8263-8276. doi:10.3748/wjg.v23.i47.8263

  5. U.S. National Library of Medicine. Non-alcoholic fatty liver disease.

  6. Houghton-Rahrig LD, Schutte DL, von Eye A, Fenton JI, Given BA, Hord NG. Exploration of a symptoms experience in people with obesity-related nonalcoholic fatty liver disease. Nurs Outlook. 2013;61(4):242-251.e2. doi:10.1016/j.outlook.2013.05.003

  7. Bugianesi E. Late complications of NASH: a challenge for hepatologists. J Hepatol. 2005;42(5):784-785. doi:10.1016/j.jhep.2005.02.007

  8. Nirengi S, Fujibayashi M, Furuno S, et al. Nonalcoholic Fatty Liver Disease in University Rugby Football Players. Front Endocrinol (Lausanne). 2018;9:341. doi:10.3389/fendo.2018.00341

  9. Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014;5(3):211-218. doi:10.1136/flgastro-2013-100403

  10. Singh S, Osna NA, Kharbanda KK. Treatment options for alcoholic and non-alcoholic fatty liver disease: A review. World J Gastroenterol. 2017;23(36):6549-6570. doi:10.3748/wjg.v23.i36.6549

  11. Perumpail BJ, Li AA, Iqbal U, et al. Potential Therapeutic Benefits of Herbs and Supplements in Patients with NAFLD. Diseases. 2018;6(3):80. doi:10.3390/diseases6030080

  12. Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015;4(2):101-108. doi:10.3978/j.issn.2304-3881.2015.01.03

  13. Zezos P, Renner EL. Liver transplantation and non-alcoholic fatty liver disease. World J Gastroenterol. 2014;20(42):15532-15538. doi:10.3748/wjg.v20.i42.15532



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