Patient education: Metabolic dysfunction-associated steatotic liver disease (The Basics)

What is metabolic dysfunction-associated steatotic liver disease? — Metabolic dysfunction-associated steatotic liver disease, or "MASLD," is a condition in which fat builds up in the liver. The liver is a big organ in the upper right side of the belly (figure 1). MASLD used to be called "nonalcoholic fatty liver disease."

When the liver has fat buildup and is inflamed, the condition is called "metabolic dysfunction-associated steatohepatitis," or "MASH." MASH used to be called "nonalcoholic steatohepatitis."

This article is mostly about MASH, because this condition can lead to the most problems.

What causes MASLD and MASH? — Doctors do not know exactly. They do know that it happens more often in some people, such as those who have:

●Excess body weight

●Diabetes, which causes blood sugar levels to get too high

●High cholesterol

●High blood pressure

What are the symptoms of MASH? — Most people with MASH (when there is liver inflammation) have no symptoms. Some people feel tired or unwell, or have discomfort in the upper belly.

Your doctor or nurse might suspect that you have MASH based on the results of your routine blood tests.

Will I need more tests? — Yes. If your doctor or nurse suspects that you have MASH, you will likely have:

●More blood tests

●An imaging test of the liver – This might be an ultrasound or MRI scan. Imaging tests create pictures of the inside of the body.

Some people need a liver biopsy. During this test, a doctor removes a small sample of tissue from the liver. Then, another doctor looks at the sample under a microscope to check for MASH. A liver biopsy is the only test that can tell for sure if you have MASH. Your doctor might do this test if they are not sure if you have MASH or to see how inflamed your liver is. If your blood tests and imaging tests are normal, you will not need a liver biopsy.

How is MASH treated? — It is not typically treated directly. But it can improve when related medical conditions get treated. For example, losing weight and controlling high blood sugar and cholesterol can help improve MASH.

Your doctor can:

●Help you lose weight, if you have excess body weight – If your doctor recommends losing weight, they can help you make a plan to do this safely. It's important not to lose weight too quickly. Do not lose more than 2 pounds (approximately 1 kilogram) a week.

●Treat your high blood sugar, if you have diabetes

●Treat your high cholesterol, if you have it

Making these changes has benefits besides helping with MASH. These changes can also lower your chances of having a heart attack or stroke. That's important because people with MASH are often also at risk for heart disease and stroke.

Your doctor might recommend other things, too. For example:

●You might get vaccines to protect against hepatitis A and B. These are infections that can harm your liver.

●If you have MASH but do not also have diabetes, your doctor might suggest that you take vitamin E. A few studies suggest that vitamin E can reduce some of the liver damage and inflammation that happens with MASH. But there are also studies that suggest that high doses of vitamin E increase the risk of death. So do not take vitamin E unless your doctor or nurse recommends it.

What can I do on my own? — You can:

●Take all of your medicines as instructed.

●Avoid alcohol. Alcohol can make liver problems worse.

●Eat a healthy diet with plenty of vegetables, fruits, and whole grains.

●Get regular physical activity. Even gentle activity, like walking, is good for your health.

●Go to all of your doctor's appointments.

Does MASH get worse over time? — It might. Sometimes, people with MASH get something called "cirrhosis." This means serious scarring of the liver. Cirrhosis can cause different symptoms, such as swelling in the legs, trouble breathing, or feeling tired.

People who have MASH need to see their doctor for regular check-ups. Your doctor will do follow-up tests regularly. These usually include blood tests.

When should I call the doctor? — Call your doctor or nurse if you have symptoms of cirrhosis. These can include:

●Blood in your bowel movements or vomit

●Symptoms of infection, such as fever over 100.4°F (38°C) or chills

●Belly pain

●Swollen legs or ankles

●Trouble breathing

●Extreme tiredness

●Confusion

●Yellowing of the skin or whites of your eyes, called jaundice

More on this topic

Patient education: Liver panel (The Basics)
Patient education: Aminotransferase tests (The Basics)
Patient education: Liver biopsy (The Basics)
Patient education: Cirrhosis (The Basics)
Patient education: Weight loss treatments (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: High cholesterol (The Basics)

Patient education: Metabolic dysfunction-associated steatotic liver disease (Beyond the Basics)
Patient education: Liver biopsy (Beyond the Basics)
Patient education: Cirrhosis (Beyond the Basics)
Patient education: Losing weight (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: High cholesterol and lipids (Beyond the Basics)