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Metabolic Dysfunction-Associated Steatosis Liver Disease

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To make an appointment with a UPMC liver care expert, call 412-647-1170 or fill out our contact form.

What Is Metabolic Dysfunction-Associated Steatosis Liver Disease (MASLD)?

Metabolic dysfunction-associated steatotic liver disease (MASLD) – formally nonalcoholic fatty liver disease (NAFLD) – is a condition in which too much fat collects within the liver in someone who doesn’t drink large amounts of alcohol.

MASLD affects about 30% of people living in the U.S.

Types of MASLD

There are two types of MASLD: steatotic liver disease and metabolic dysfunction-associated steatohepatitis (MASH).

While people will have fat in the liver with both types, they differ in some major ways.

  • Steatotic liver disease. People with this type have little or no swelling of the liver and no liver cell damage. MASLD liver disease typically doesn't cause any permanent liver damage.
  • 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.

Causes of 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.

The most common ones include:

  • Type-2 diabetes.
  • Obesity, especially with a large waist size.
  • Insulin resistance or prediabetes.
  • Metabolic syndrome.
  • High cholesterol (mainly LDL or "bad" cholesterol) or triglyceride levels.
  • High blood pressure.
  • Sleep apnea.
  • Polycystic ovarian disease.

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 and complications

Certain groups of people are more at risk of developing MASLD.

Some studies have shown that MASLD:

  • Becomes more common in people over 50.
  • Is more common in men.
  • Affects people with high blood pressure and/or high cholesterol.
  • Occurs more often among people with a Hispanic ethnic background.
  • Is higher among those who drink soft drinks with high-fructose corn syrup.

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 to 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 those health conditions.

  • Maintain a healthy body weight. (A BMI of 25 or more is overweight, while a BMI of 30 or more is obese.)
  • Eat more whole, unprocessed foods — such as whole grains, beans, fruits, and veggies — and strictly limit processed and fatty foods.
  • Limit daily sugar intake, following guidelines from the American Heart Association. Women should eat no more than 100 calories (25 grams or 6 teaspoons) from added sugar daily. Men should limit added sugars to 150 calories (36 grams or 9 teaspoons) daily.
  • Get 30 to 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, which can also cause fat to build up in the liver.

For more information on how to treat MASLD, visit our UPMC Liver Steatosis and Metabolic Wellness Program website.

Why Choose the UPMC Center for Liver Care for MASLD Care?

Our world-renowned liver care experts:

  • Treat the full range of liver conditions including MASLD and offer the latest, cutting-edge treatments.
  • Partner with you to provide lifestyle and diet changes, as well as counseling services with mental health experts.
  • Work closely with the UPMC Liver Cancer Center and the UPMC Liver Transplant Program. This allows us to provide you with complete and seamless care for any serious complications from MASLD.

MASLD Symptoms and Diagnosis

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.
  • Weight loss, loss of appetite, and nausea.
  • Stomach pain.
  • Jaundice (yellowing of the skin and eyes).
  • Itching.
  • Fluid retention or swelling of the legs and belly.
  • Mental confusion.

Diagnosing MASLD

If your doctor thinks you might have MASLD, they will order or perform one or more of these tests:

  • Blood tests.
  • Endoscopy (diagnostic and therapeutic).
  • Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP).
  • Esophageal variceal banding.
  • Liver biopsy.
  • Non-invasive liver imaging (Fibroscan).
  • Paracentesis.
  • Thoracentesis.
  • Transjugular intrahepatic portosystemic shunt (TIPS).

MASLD Treatment

For mild cases of MASLD, the main goal of treatment is to avoid serious problems by preventing the disease from getting worse. For more serious cases of MASLD, our goal is to restore function to the liver.

Lifestyle changes to treat mild MASLD

For mild cases of MASLD, the main treatment at UPMC focuses on addressing the risk factors, like making lifestyle changes.

Lifestyle changes that can help slow the progression of MASLD include:

  • Staying at a healthy weight.
  • Eating a healthy diet.
  • Exercising routinely.
  • Limiting alcohol intake.
  • Taking only medicines 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.

Treatment options 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.

Treatment options for severe MASLD or NASH

For severe cases of MASLD or NASH, your doctor might:

  • Suggest bariatric surgery if you're obese with advanced MASLD and struggle with weight loss.
  • Talk to you about a liver transplant if liver scarring is extensive and extremely limits liver function.

To learn more about MASLD, or to make an appointment at the UPMC Center for Liver Care, call 412-647-1170.