Overview
The liver is the most multitasking organ in our body: there are more than 500 functions of the liver identified. The main ones are bile production and food digestion, several blood protein formation, glucose storage in a form of glycogen, clearing the blood from poisonous substances, etc. Several diseases affect the liver, but the most common are viral hepatitis (hepatitis A, B, C) and metabolic dysfunction-associated steatotic liver disease, or “МΑЅLD”. MASLD used to be called non-alcoholic fatty liver disease: it’s a condition of excess fat accumulation in liver cells (steatosis).
The exact mechanism and factors why fat builds up in some livers and not in others are not clear, but several known factors affect the development of MASLD.
Epidemiology and risk factors
The global rates of MASLD continue to rise, in accordance with increased rates of obesity and diabetes mellitus type 2. Currently, 38% of all adults and 7-14% of children and adolescents have MASLD. By 2040, the MASLD prevalence rate for adults is projected to increase to over 55%.
The most common risk factors for developing MASLD
- overweight and obesity
- hyperlipidemia (high blood triglyceride or cholesterol levels)
- insulin resistance (diabetes or prediabetes)
- high blood pressure
The combination of these four is called “metabolic syndrome”.
Other risk factors are:
- age over 50
- smoking
- hypothyroidism (underactive thyroid)
- genetic factors (family history of MASLD or obesity)
- polycystic ovary syndrome
- obstructive sleep apnea
Stages and symptoms
MASLD could vary from simple fatty liver to life-threatening cirrhosis and liver cancer. The main stages are:
| Stages | Definition | Symptoms |
| MASLD | simple fat buildup | no symptoms |
| ΜΑЅH (metabolic dysfunction-associated ѕtеаtοhepatitiѕ) | fat buildup and inflammation | * fatigue * weight loss * tiredness * discomfort in upper-right abdomen |
| fibrosis | * scar tissue formation around blood vessels * liver function is normal | |
| cirrhosis | * permanent damage of liver cells * liver failure | * jaundice (yellowing skin or scleras) * ascites (fluid buildup in abdomen) * esophageal varices (swollen veins of esophagus), rupture and bleeding * heart failure * hepatic encephalopathy (confusion, sleepiness)liver failureliver cancer |
Contact your GP if you have any of these symptoms.
Diagnosis and treatment
At first stages, diagnosis is made unintentionally, after routine blood tests. In most people, there are elevated levels of two liver enzymes: aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Viral hepatitis should be excluded. Imaging tests, like abdominal ultrasound, MRI and CT scan, are also used for diagnosis, but sometimes, a liver biopsy is needed for definitive decision-making. For determining if there is cirrhosis or not, transient elastography is used. This study uses ultrasound to determine the “stiffness” of the liver by measuring scar tissue.
Treatment is based on curing MASH associated conditions: lowering blood pressure and blood glucose, weight loss and healthy diet, lipid-lowering therapy, avoiding alcohol.
MASH is a lifelong condition. Weight loss generally improves or reverses MASH. Good news is not all people with MASLD or MASH develop liver cirrhosis, but sometimes, when it happens, liver transplantation could be needed.
FAQ about Fatty Liver disease:
- What is the main risk factor for fatty liver?
The main risk factor is metabolic syndrome.
- Is MASLD reversible?
Yes, healthy diet and lifestyle, weight loss could reverse MASLD.
- Is there a medicine to treat MASLD.
No, There is no FDA approved medication for MASLD treatment.
Sources:
UpToDate
Mayo Clinic
National Health Service UK
