Fatty liver disease (MASLD/MASH)

What is it?

In this condition fat builds up in the liver.¹ Its new name is MASLD (metabolic dysfunction-associated steatotic liver disease); it used to be called NAFLD.^1,2 It is not caused by heavy drinking.² There are four stages: fat alone (most people only have this and it does not usually cause problems); fat with inflammation (MASH, once called NASH); fibrosis (scarring); and cirrhosis, severe damage that affects how well the liver works.^1,2

It is very common: it is the most common long-term liver disease.^2,1 It is more likely if you are overweight, especially around the waist, if you have type 2 diabetes, high blood pressure or high cholesterol, if you are not very active, or if you are over 50.¹ Children can get it too.² The exact cause is not known.²

The first signs

Usually there are no signs, and it is often found during tests for something else.¹

• feeling extremely tired;¹
• feeling generally unwell;¹
• discomfort or pain at the top right of the tummy, under the ribs.^1,2

How doctors find out

It is usually found after blood tests or scans done for another reason show signs of problems with your liver.^1,2 Your family doctor asks about your symptoms and how much alcohol you drink, and measures your height, weight and waist.¹ More blood tests and sometimes an ultrasound scan of your tummy can show the fat, rule out other causes and check for liver damage.¹ If there is damage to your liver, you will need to see a liver specialist in hospital. Sometimes a biopsy is done to confirm the diagnosis and check for liver damage.^1,2

Current treatment

Lifestyle changes for everyone (healthy diet, at least 150 minutes of exercise a week, weight loss, little alcohol, no smoking), with pioglitazone or vitamin E from a specialist if there is scarring.Source: NHS

Will it get worse?

Most people only ever have the first stage, which usually causes no problems.¹ A small number go on to inflammation and scarring, and some to cirrhosis, which can lead to bleeding inside the body, liver failure or liver cancer.^1,2 It is also linked to heart disease, kidney disease, high blood pressure and type 2 diabetes.¹ Healthy changes lower all these risks.¹

Medicines: what helps, and what to watch for

If there is scarring, a liver specialist may prescribe pioglitazone or vitamin E.¹ For people with obesity, specialists may suggest weight-loss medicines.¹ More research is needed to know which medicines are safe and work well.²

Healthy changes help most

• exercise for at least 150 minutes a week;¹
• lose weight if you are overweight: it can reduce the fat, inflammation and scarring;^1,2

Weight-loss surgery or a transplant, for some people

For people with obesity, a specialist may recommend weight-loss surgery.¹ In very severe cases, when the liver fails, a liver transplant may be needed.^1,2

Can it get better?

Healthy changes can reduce the fat in the liver and may repair damage or stop it getting worse.¹ More studies are needed to see whether certain medicines are safe and work well to treat MASLD; studies are listed on ClinicalTrials.gov.²

See the 424 trials you can join

Sources

Written in plain words by Frontlight from these pages:

1. NHS: Non-alcoholic fatty liver disease (NAFLD)
2. MedlinePlus: Steatotic Liver Disease (Fatty Liver Disease)