Last week we talked about liver disease caused by fat buildup in the liver, including the causes, risk factors, and symptoms. This is an increasingly common condition that is estimated to affect 9 to 15 million adults in the US, and the prevalence is projected to increase by over 60% by 2030. It is a leading cause of cirrhosis and liver transplantation and can lead to liver cancer. Today, we will talk about the complications of this condition, along with diagnosis, treatment, and prevention.
Let’s start with a quick review of the names.
Metabolic dysfunction associated steatotic liver disease, abbreviated MASLD (previously called NAFLD or nonalcoholic fatty liver disease) is fat buildup within the liver, without permanent damage to the liver. Metabolic dysfunction associated steatohepatitis, abbreviated MASH (previously called NASH or nonalcoholic steatohepatitis) is progression of MASLD to inflammation of the liver, which leads to permanent scarring, and can ultimately lead to cirrhosis with the potential for liver failure.Who gets MASLD?
Most people with MASLD are between the ages of 40-60 years old, but it can affect younger adults and even children. It is more common in women than men. You can review the risk factors and causes in last week’s article.
How are MASLD and MASH diagnosed?
Most people with MASLD and early MASH have no symptoms. There are no current medical guidelines for screening recommended for MASLD. For this reason, the diagnosis of MASLD/MASH is often made incidentally, when it is discovered on routine blood tests or tests done for another medical condition.
Here are some of the tests done to diagnose MASLD, to rule out other diseases, or to assess liver damage:
Blood tests include:
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Liver enzymes and tests of liver function
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Complete blood count (CBC)
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Tests for various types of viral hepatitis (Hepatitis A, B, C, and others)
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Iron studies
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Celiac disease screening test
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Blood sugar testing, including hemoglobin A1c
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Lipid profile, showing cholesterol and triglycerides
Imaging tests include:
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Ultrasound of the abdomen
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MRI or CT scan of the abdomen
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Elastography – A new type of specialized ultrasound, which may be combined with an MRI, that measures the stiffness of the liver and surrounding tissues.
Liver Biopsy
This may be done if other tests show signs of more advanced liver disease or if the other tests do not provide a clear diagnosis.
What are the possible complications of MASLD and MASH?
The primary complication is cirrhosis. The liver is trying to combat inflammation, which unfortunately leads to scar tissue that replaces liver cells. This can lead to a type of high blood pressure within the veins of the liver (called portal hypertension), which can affect many surrounding structures. The scar tissue can eventually replace most of functioning liver tissue. Here are some of the symptoms of cirrhosis and portal hypertension:
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Fluid buildup in the abdomen (ascites)
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Varicose veins within the esophagus, which can rupture and cause life-threatening hemorrhage
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Enlarged, overactive spleen, which can cause blood not to clot properly
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Changes in brain function, leading to confusion, slurred speech, drowsiness, and even coma.
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Liver cancer
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Complete loss of liver function, called end-stage liver failure
How are MASLD and MASH treated?
Treatment for MASLD starts with weight loss, increased exercise, and treating high lipid levels. Losing 10% of body weight is the goal but even 3-5% weight loss can help.
There is a new medication to help reduce the amount of fat deposited in the liver, but it needs to be used earlier in the disease process. It is not recommended once cirrhosis has developed.
There are a number of medications that can be used to treat the signs and symptoms of cirrhosis, but they do not cure it.
Liver transplant may be needed for people with cirrhosis from MASH.
How can you prevent or reduce your risk of MASLD and MASH?
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Eat a healthy diet rich in vegetables, fruits, whole grains, and healthy fats.
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Limit alcohol, simple sugars (sugary drinks, high fructose corn syrup, highly processed foods), and limit portion sizes.
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Exercise regularly – Be active most days of the week and try to get as much structured exercise as you can. If you have not been exercising regularly, talk to your doctor about exercise first.
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Maintain a healthy weight – If you are overweight, talk with your doctor about a plan to gradually lose weight. If you are a normal weight, work to keep your weight in that range. It is harder to lose weight than to keep it off. And it often becomes harder to maintain a healthy weight as we get older.
If you have any questions about fatty liver disease, please log into your account and send us your question. We are here to help.
Dr. Anita Bennett MD – Health Tip Content Editor