MASLD MASH

People often think that liver disease stems from drinking alcohol. That’s not always the case. Two relatively common diseases—metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH)—have no connection to alcohol. But if you have them, you shouldn’t drink as it can further damage the liver. MASLD is the precursor to MASH. If you leave MASLD untreated, it can develop into MASH, which is the more severe form of the disease. According to the American Liver Association, about 25 percent of the population have MASLD and between 9 and 15 million American have MASH.

Many people have fat in their livers. Those who also develop liver injury, inflammation, and scarring of the liver are at risk of progressing to cirrhosis. Early treatment can help prevent cirrhosis.

Anyone can develop MASLD/MASH, regardless of age, gender, or health status. But it is somewhat more likely to develop in people who are:

Overweight, obese, or have excess weight around the waist
Prediabetic or have type 2 diabetes
Facing high cholesterol or high triglycerides
Ages 40-60
Post-menopausal women
Latino or Asian
Have obstructive sleep apnea

Generally, though, there are no obvious causes of MASLD/MASH. People of all ages, genders, and health statuses can develop the condition.

Diagnosis

Most people with MASLD/MASH have no symptoms. We usually suspect it because of bloodwork done for another condition or at the annual physical. If your liver enzymes are high, your doctor might send you to a liver specialist who can confirm the diagnosis of MASH. Another indication is an abdominal ultrasound showing that your liver is enlarged and has excess fat.

We diagnose MASH using several techniques:

A thorough medical history
A physical exam
Blood tests that look at liver function, fibrosis, lipid parameters, and other risk factors
Imaging tests, which might include a specialized ultrasound (called transient elastography) and magnetic resonance imaging

Sometimes, we make the definitive diagnosis based on a liver biopsy, which involves removing a small piece of your liver and sending it to the lab for testing.

Treatments We Offer

Our goal is to treat MASLD before it develops into MASH. This can involve several approaches.

Lifestyle Changes: The goal is to avoid any further damage to the liver. Changes include:

Losing weight through diet and exercise
Controlling diabetes
Keeping your cholesterol and triglyceride levels within normal range
Avoiding alcohol
Be careful about dietary supplements such as vitamin A, iron, and niacin and any herbal remedies; check with your doctor to make sure they will not hurt your liver.
Getting vaccinated for hepatitis A and hepatitis B

Medication: In March 2024, the U.S. Food and Drug Administration approved the first therapy for MASH, resmetirom. You take it by mouth once a day. The drug is indicated for those who have some fibrosis/scarring of the liver but do not yet have cirrhosis.