Metabolic dysfunction-associated steatotic liver disease (MASLD) — formally called nonalcoholic fatty liver disease (NAFLD) — is a condition that occurs when too much fat collects within the liver in someone who doesn’t drink large amounts of alcohol.
UPMC experts provide complete care for MASLD, including support with lifestyle and diet changes.
On this page:
What Is MASLD?
Metabolic dysfunction-associated steatotic liver disease (MASLD) — formally called nonalcoholic fatty liver disease (NAFLD) — is a condition that occurs when too much fat collects within the liver in someone who doesn’t drink large amounts of alcohol.
What are the types of MASLD?
There are two types of MASLD, including:
- Steatotic liver disease — People with this type have little or no swelling of the liver and no liver cell damage. MASLD typically doesn't cause any permanent liver damage if treated early.
- MASH — By contrast, people with MASH will have swelling of the liver and liver cell damage. MASH can cause fibrosis (or scarring) of the liver and may lead to cirrhosis or liver cancer.
How common is MASLD?
MASLD affects about 30 percent of people living in the U.S.
What causes MASLD?
Experts aren't quite sure what causes MASLD. Research suggests that people are more likely to develop MASLD if they also have other health conditions, including:
- High blood pressure.
- High cholesterol (mainly LDL or "bad" cholesterol) or triglyceride levels.
- Insulin resistance or prediabetes.
- Metabolic syndrome.
- Obesity, especially with a large waist size.
- Polycystic ovarian disease.
- Sleep apnea.
- Type 2 diabetes.
Research suggests that certain genes or having your gallbladder removed may also make you more likely to get MASLD.
Research also links some drugs — including steroids and synthetic estrogen — to an increased risk of MASLD.
MASLD risk factors
Certain groups of people are at higher risk of developing MASLD, including:
- Men.
- People over age 50.
- People with a Hispanic ethnic background.
- People with high blood pressure and/or high cholesterol.
- People who drink soft drinks with high-fructose corn syrup.
Complications of MASLD
If left untreated, MASLD may lead to swelling and scarring (cirrhosis) in the liver. Over time, it may even lead to liver cancer or liver failure.
How can I prevent MASLD?
MASLD is most commonly linked to health conditions related to diet and lifestyle.
To reduce your risk of MASLD, you can make choices that reduce your chances of developing chronic health conditions, including:
- Maintaining a healthy body weight — A BMI of 25 or more is overweight and a BMI of 30 or more is obese.
- Eating more whole, unprocessed foods — Focus on eating whole grains, beans, fruits, and veggies, and strictly limit processed and fatty foods.
- Limiting daily sugar intake — According to the American Heart Association, women should eat no more than 100 calories (25 grams or six teaspoons) from added sugar daily. Men should limit added sugars to 150 calories (36 grams or nine teaspoons) daily.
- Get 30-60 minutes of exercise daily — A brisk walk, swimming, or anything else that raises your heart rate will help.
You should also reduce or eliminate alcohol intake, which can also cause fat to build up in the liver.
What Are the Signs and Symptoms of MASLD?
Most people with MASLD don't have symptoms in its early stages. Doctors usually discover it because of an abnormal liver function test or during testing for an unrelated health issue.
When MASLD symptoms do occur, they may include:
- Fatigue and weakness.
- Fluid retention or swelling of the legs and belly.
- Itching.
- Jaundice (yellowing of the skin and eyes).
- Mental confusion.
- Stomach pain.
- Weight loss, loss of appetite, and nausea.
When should I see a doctor about my MASLD symptoms?
If you have symptoms of MASLD, you should schedule an appointment with your doctor right away. Early diagnosis and lifestyle changes may slow, stop, or reverse the disease.
How Do You Diagnose MASLD?
To diagnose MASLD, your doctor will perform a physical exam and review your symptoms and medical history. Your doctor will also order tests.
What to expect during your visit
To diagnose MASLD, your doctor will:
- Ask you about your symptoms.
- Order diagnostic tests.
- Perform a physical exam.
- Review your medical history.
Tests to diagnose MASLD
If your doctor thinks you might have MASLD, they will order or perform one or more of these tests:
- Blood tests — Check for signs that your liver isn’t functioning properly.
- Endoscopy — Allows your doctor to examine the inside of your digestive tract using a thin, flexible tube with a light and camera on the end called an endoscope.
- Liver biopsy — A procedure that uses a small needle to take a sample of liver tissue for analysis in the lab.
- Noninvasive liver imaging (FibroScan) — A test that uses vibrations to check for fat content (steatosis) and scarring of the liver. It is sometimes performed as a noninvasive alternative to liver biopsy.
MASLD prognosis
Mild cases of MASLD typically respond well to lifestyle changes. These include reducing or eliminating alcohol consumption, eating a healthy diet, maintaining a healthy weight, and getting regular exercise. In some cases, lifestyle changes can slow, stop, or reverse the progression of MASLD.
However, without treatment, MASLD can progress and lead to serious complications such as cirrhosis, liver cancer, and liver failure.
How Do You Treat MASLD?
For mild cases of MASLD, the main goal is to prevent the disease from getting worse and to avoid serious complications. For more severe cases of MASLD, our aim is to restore liver function.
Treatment options for MASLD may include:
Lifestyle changes for mild MASLD
For mild cases of MASLD, the primary treatment at UPMC focuses on addressing risk factors and making lifestyle changes.
Lifestyle changes that can help slow the progression of MASLD include:
- Eating a healthy diet.
- Exercising routinely.
- Limiting alcohol intake.
- Staying at a healthy weight.
- Only taking medicine that you need and following the prescribed dosing.
We will work with you on a weight loss regimen and a set of goals to improve the health of your liver.
Lifestyle changes and medications for moderate MASLD
For moderate cases of MASLD, your doctor might:
- Suggest a more rigorous diet or meal replacement plan.
- Combine lifestyle changes with medications.
- Regularly check the health of your liver to avoid progression of disease into advanced stages.
Surgical treatment for severe MASLD
For severe cases of MASLD, your doctor might:
- Suggest bariatric surgery if you're obese with advanced MASLD and have not been able to lose weight with diet and exercise alone.
- Talk to you about a liver transplant if liver scarring is extensive and limits liver function.
Why Choose UPMC for MASLD Care?
When you choose UPMC for MASLD care, you will receive:
- Access to board-certified specialists — Our hepatologists treat the full range of liver conditions, including MASLD, and offer the latest, leading-edge treatments.
- Expert diagnosis and personalized care — Our team partners with you to make healthy lifestyle and diet changes, providing referrals for supportive care.
- A full range of treatment options — Our team works closely with UPMC liver cancer and liver transplant experts to provide you with complete and seamless care for any serious complications of MASLD.
