Articles

Updated as of: 2-20-2024

1. MASLD-1 (Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent worldwide due to the rising rates of diabetes and obesity. This poses a significant health challenge, particularly for individuals facing food insecurity, who often resort to inexpensive but unhealthy food choices, exacerbating the risk of MASLD-related complications. Predictions indicate that by 2040, over half of the adults may have MASLD due to the increasing obesity rates, and around 20-30% of MASLD cases may progress to more severe liver conditions. In Arizona, MASLD is a growing concern, especially among those with limited access to nutritious foods due to transportation issues, living in food deserts, and socioeconomic constraints. 

What is Metabolic-associated steatotic liver disease (MASLD), and what was it previously known as? 

 Metabolic-associated steatotic liver disease (MASLD) is a liver condition that used to be called non-alcoholic fatty liver disease (NAFLD). MASLD happens when fat builds up in the liver due to metabolic issues like diabetes, obesity, high blood pressure, or high cholesterol, even if alcohol intake is low. It's previously known as non-alcoholic fatty liver disease (NAFLD). Insulin resistance, dietary factors high in carbohydrates and sugars, and genetics can contribute to fat accumulation. Some people with MASLD develop inflammation in the liver and damage to liver cells, known as steatohepatitis or MASH(Metabolic dysfunction-associated steatohepatitis), which is a more severe form of the condition. 

Why was there a change in terminology from NAFLD to MASLD? 

The change from NAFLD to MASLD reflects a broader understanding of the condition, recognizing its spectrum from simple fat buildup to advanced liver damage like fibrosis and cirrhosis. 

How common are MASLD and MASH? 

MASLD affects up to 30 out of 100 people, or 30% of the US population. It's the most common liver disorder globally, especially as conditions like obesity and diabetes increase. 

Who is at risk for MASLD and MASH? 

People with 1 or more features of metabolic syndrome are more at risk for MASLD.  

With similar lifestyles and genetics, people with a family history of MASLD may also be at higher risk of developing the disease.  

Metabolic syndrome is defined as having 3 or more of the following features: 

• Obesity (having a body mass index (BMI) greater than or equal to 30), particularly those with a large waistline or abdominal (belly) obesity 

• Pre-diabetes or diabetes (People with MASLD and diabetes have a greater risk for MASH) 

• Low HDL cholesterol (low levels of good cholesterol) 

• High lipids (fat) called triglycerides 

• High blood pressure 

Why is the adoption of the updated terminology by major liver study societies significant? 

The adoption of MASLD by major liver study societies shows a significant evolution in how we understand and perceive liver diseases, highlighting the importance of recognizing the condition's complexity and severity. 

What other health conditions are closely associated with MASLD? 

 MASLD is closely linked with metabolic syndrome and cardiovascular disease, sharing common risk factors and disease mechanisms. 

How does MASLD impact overall health beyond just the liver? 

MASLD has a systemic and dysmetabolic nature, affecting more than just the liver and emphasizing the need for comprehensive management strategies that address both liver and cardiovascular health. 

What signs and symptoms might someone with MASLD experience?  

Many people with MASLD don't have symptoms, but some might feel tired, unwell, or have discomfort in the upper right part of the belly. The liver might also become enlarged, and in severe cases, the spleen could enlarge too. 

What are the Health risks of MASLD? 

MASLD patients are at an increased risk of developing serious conditions like heart disease and diabetes. Heart disease is the leading cause of death in MASLD patients. 

What are the Health risks from MASH? 

People with MASH face a higher risk of heart disease, including heart attacks and high blood pressure. About 20% of MASH patients may develop severe liver scarring known as cirrhosis. 

What are the Health issues related to cirrhosis? 

Cirrhosis occurs when liver cells are damaged, leading to scar tissue formation. This condition causes changes in blood flow through the liver, resulting in high pressure in the liver's blood vessels, called portal hypertension. Over time, cirrhosis can lead to complications such as varices (enlarged blood vessels that can bleed internally), ascites (fluid buildup in the abdomen and legs), hepatic encephalopathy (confusion and sleepiness due to toxin buildup), and an increased risk of liver cancer. 

Resources  

Fatty Liver (higadograso.org)-Patient education materials in Spanish 

Online Support Groups - American Liver Foundation-Support groups for liver diseases. 

Arizona State Resource Center - American Liver Foundation-State resources for liver diseases. 


2. Health Literacy

You may have heard of the term health literacy recently. Personal health literacy is people’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. 9 out of 10 Americans have limited health literacy, which is linked to poor health outcomes such as longer hospital stays, chronic conditions, and trouble managing them. 

According to the definition of health literacy, you first must be able to find information and services. AZHEALTHTXT is an excellent source of credible, timely health information. Other trusted, credible organizations can be local, statewide, or national. The Arizona Department of Health Services (ADHS) Director’s Blog posts health information and alerts, which you can receive in your email. Centers for Disease Control and Prevention (CDC) website allows you to search any health topic to find detailed information. Sources like Mayo Clinic have information to help you learn more about different diseases and conditions, drugs and supplements, and even symptoms. Health-promoting organizations are plentiful, and searching the internet for your needs and location can yield many useful results. The internet is an excellent way to find health-related information from various sources, but knowing how to distinguish a trusted source from an untrustworthy one is key. Use this article as a quick guide to determine if a source is trusted.  

The second part of health literacy is understanding the information and services that you have found. Just because a source is trusted does not mean the information is easily understandable, especially as it applies to our health and the health of loved ones. Sometimes it is necessary to seek other sources that can more easily translate health information. YouTube is an excellent source to find credible sources such as academic, medical, and government organizations that will explain the health information you find in audiovisual format. For example, this video by Blue Cross Blue Shield of Michigan gives a quick overview of what health literacy is. 

The third part of health literacy is using the information you find and understand, to apply it to health-related decisions you will make going forward. Speaking to healthcare providers can be intimidating, but there are many tips you can use to improve communication with your provider. Consider making a list of topics you want to address or questions you have. Bring supplements, medications, and other remedies you use to learn about potential interactions and dosage. Also consider taking a pen and paper to write down important information during your appointments. During your appointment, be sure to answer questions honestly and ask questions if you are unsure about what your provider says. You can also ask your provider for written or printed instructions.  

More tips for improving communication with your provider can be found here:  

Achieving health literacy is a process that is critical to maintaining optimal health and functioning effectively within the healthcare system. This means more health, less confusion and stress related to adverse health, and better outcomes for you and your family. 

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