Q: What is MASLD?
A: MASLD is the most common form of chronic liver disease and occurs when extra fat collects in the liver. It’s often found in people with metabolic issues, such as high blood pressure, obesity and type 2 diabetes. These conditions interfere with your body’s metabolism or how your body breaks down food to use as energy. In MASLD, fat slowly builds up in your liver cells and can cause inflammation and eventually scarring of the liver if not treated.
Q: What causes MASLD?
A: The liver’s job, among other things, is to digest fat. When the liver cannot process fat efficiently or when there is an excessive intake of fat, it leads to fat accumulation in liver cells. When too much fat builds up in liver cells, it can cause inflammation, scarring and liver failure. Contrary to popular belief, MASLD is not caused by drinking too much alcohol. In fact, it can be genetic and caused by having a poor diet, not exercising, taking certain medications, being obese, losing weight rapidly and metabolic syndrome (a cluster of conditions like high blood pressure, high blood sugar and high triglycerides).
Other causes of MASLD include:
- A body mass index of 30 or higher
- Extra weight in the stomach and waistline area
- High levels of lipids or cholesterol
- Prediabetes and type 2 diabetes
Q: What are the symptoms of MASLD?
A: Not everyone experiences MASLD symptoms, and most people don’t have any symptoms at all. It can take several years or even decades to show any signs of MASLD. People with symptoms may experience them in the early stages of MASLD or when the condition is more advanced.
Early symptoms:
- Abdominal pain or discomfort
- Elevated liver enzymes
- Fatigue
- Feeling unwell with no explanation/malaise
Advanced symptoms:
- Aching in your upper right abdomen
- Bruising and bleeding
- Dark urine
- Enlarged spleen
- Extreme fatigue
- Itchy skin
- Jaundice (yellowing of your skin and eyes)
- Loss of appetite
- Memory loss
- Mental confusion
- Nausea
- Swollen abdomen
- Swollen legs and ankles
- Vomiting
- Weakness
- Weight loss
Q: Who is at risk for MASLD?
A: Certain conditions increase your risk of developing MASLD, as well as having a family history. Also, in the United States, Hispanic people have higher rates and more severe MASLD. If you have any of the following conditions, you may be at a higher risk for MASLD:
- High blood pressure
- High cholesterol
- Obesity, especially with a large waist size (40 inches for men and 35 inches for women)
- Polycystic ovarian syndrome (PCOS)
- Malnutrition or rapid weight loss
- Sleep apnea
- Type 2 diabetes
- Underactive thyroid or pituitary gland
Q: How will my doctor test for MASLD?
A: Your doctor will likely use a combination of tests that examine liver function, fat content and fibrosis. Tests may include the following:
- Blood tests
- Liver biopsy
- MRI of the liver
- Physical exam
- Transient Elastography (FibroScan, a non-invasive test that measures liver stiffness using sound waves)
- Ultrasound of the liver
Q: Are there complications from MASLD?
A: MASLD can progress to a more severe condition known as metabolic dysfunction-associated steatohepatitis (MASH). In MASH, the liver becomes inflamed and damaged, which can lead to several complications:
- Liver Fibrosis: This is the initial buildup of scar tissue in the liver as it tries to repair itself.
- Cirrhosis: Over time, extensive scarring can occur, severely reducing liver function and potentially causing liver failure.
- Hepatocellular Carcinoma (HCC): In advanced cases, especially with cirrhosis, MASLD increases the risk of developing this form of liver cancer.
The journey from MASLD to these severe outcomes is usually gradual. Studies suggest that only about 3–5% of people with MASLD develop cirrhosis over 20 years.
Q: How is MASLD treated?
A: Treatment of MASLD focuses primarily on lifestyle changes to reduce liver fat and improve health. The most effective strategy is weight loss, aiming for a 5-10% reduction in body weight through a healthy diet—low in saturated fats, trans fats, cholesterol and added sugars, while rich in fruits, vegetables, whole grains and lean proteins—paired with regular exercise, such as 150 minutes of moderate activity per week. These steps can improve liver function and potentially reverse early-stage MASLD.
For those with advanced MASLD or difficulty losing weight, additional treatments may be needed. Options include weight loss medications like semaglutide or tirzepatide or bariatric surgery for severe obesity. Antioxidants like vitamin E may be used in specific cases (such as non-diabetic adults with confirmed MASLD) to reduce liver inflammation. However, its use is not standard for all patients.
A new medication, resmetirom—a thyroid hormone receptor agonist—has shown promise in reducing liver fat and scar tissue and improving liver health in clinical trials, offering a targeted treatment for some patients with MASLD and liver scarring. Regular monitoring and follow-up with your doctor are also important to manage MASLD and prevent progression.
Q: Will I need a liver transplant if I have MASLD?
A: A Liver transplant is not a common outcome for patients with MASLD, but it may be necessary in severe cases where the liver is irreversibly damaged. It is reserved for cases where the liver sustains irreversible damage, typically due to the development of cirrhosis or hepatocellular carcinoma (liver cancer). For a transplant to be necessary, MASLD would need to progress to a point where the liver’s functionality is critically compromised, often indicated by symptoms such as jaundice, ascites (fluid buildup in the abdomen) or hepatic encephalopathy (brain dysfunction due to liver failure). The decision to pursue a transplant involves extensive medical evaluation, including imaging, liver function tests, and assessment of overall health, as it’s a major surgery with significant risks and lifelong implications, such as immunosuppressive therapy. Fortunately, only a small fraction of MASLD patients reach this critical stage, and proactive management can often avert the need for such an extreme intervention.
Q: How can I lower my risk for MASLD?
A: There are several ways to lower your risk of MASLD, and in some cases, especially in the early stages, it can even be reversed. One significant way to reduce your risk is to make lifestyle changes, such as losing weight, eating a healthy diet and getting regular exercise. Make sure to consult with your doctor or a registered dietitian to create a plan that’s right for you. Other ways to lower your risk include:
- Control diabetes
- Eat whole foods
- Get vaccinated for hepatitis A and B (these vaccines protect overall liver health, though they don’t directly prevent MASLD)
- Limit processed foods
- Limit alcohol
- Lower cholesterol and triglycerides
- Lower blood pressure
- Talk to your doctor about medications you’re taking
Q: When should I call my doctor?
A: You should call your doctor if you experience any of the symptoms listed above, especially if you’re more tired than usual or have pain in the upper right part of your stomach. These symptoms might indicate that you could be developing MASH. Your doctor may refer you to a liver specialist to help maintain your liver health and monitor your progress.
