MASLD-1 (Metabolic Dysfunction-Associated Steatotic Liver Disease

Feb. 20, 2024

Anandalakshmi Ponnaluri, MBBS

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.