Is your liver also fat? Let's talk about Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Have you ever thought that the extra weight you carry or a condition like diabetes you have can also affect your liver? Sometimes, we unknowingly start to accumulate fat in our liver. That is one of the conditions we are going to talk about today, which is called MASLD. Don't worry, let's understand this simply.

What is this MASLD?

Simply put, MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) is a liver disease caused by an excessive accumulation of fat inside your liver cells. It is also called steatotic (fatty) liver disease (SLD) . It was previously called NAFLD (Nonalcoholic Fatty Liver Disease), which means that fat accumulates in the liver for reasons *not* due to alcohol consumption. But now this name has been changed to MASLD, because it has been found to be directly related to certain abnormalities in our body's metabolism.

Just like the accumulation of garbage in our homes, when fat accumulates in the liver, over time it can cause hepatitis, which is inflammation of the liver. This condition is one of the most common chronic liver diseases in the world. It is especially common among people with obesity and type 2 diabetes. As these conditions increase, experts estimate that more than 30% of the world's population may have MASLD. If left untreated, MASLD can lead to more serious liver diseases. Therefore, early detection and treatment can prevent this condition from getting worse.

What are the symptoms of MASLD?

Often, this condition called MASLD can develop for years without showing any symptoms in the early stages. This means that the disease can be present inside your body without you feeling any difference. Think of it as a problem that grows insidiously.

However, some symptoms start to appear when this condition reaches a more severe stage called MASH (Metabolic Dysfunction-Associated Steatohepatitis). MASH is when fat accumulates in the liver and begins to damage the liver along with inflammation. This can lead to conditions such as liver fibrosis, which is the formation of scar tissue, or cirrhosis. If this happens, you may experience symptoms such as:

• You have some pain or discomfort in the upper right part of your abdomen, where your liver is located .
• Feeling unimaginably tired and lifeless.
• The food is tasteless.
• Feeling like your stomach is bloated.
• Being thin for no reason.
• Your skin and the whites of your eyes turn yellow (like jaundice, doctors also call this scleral icterus ).

If you have one or more of these symptoms, it is important to seek medical advice.

What are the causes of MASLD?

The main reason for developing MASLD is the occurrence of some abnormalities in the metabolic process of your body. This metabolism is the process by which the food we eat is converted into energy. If there is any problem in this process, MASLD can occur. Here are some of the main factors that affect this:

• Dyslipidemia: This is when the levels of fats in your blood, especially lipids like cholesterol, are higher than normal.
• Obesity: If your Body Mass Index (BMI) is 30 or higher, you are considered obese. People with excess fat, especially around the belly, are at higher risk of developing MASLD.
• Insulin resistance: Insulin is a hormone that controls the level of sugar (glucose) in our blood. Insulin resistance means that your muscle, fat cells, and liver cells do not respond properly to insulin. This makes it difficult to control blood sugar levels.
• Type 2 diabetes: This is also a long-term condition. What happens here is that blood sugar levels are constantly high (hyperglycemia).

In addition to these factors, research has found that certain genetic variations may also increase the risk of developing MASLD.

What are the possible complications of MASLD?

We've already talked about how some people with MASLD can develop a condition called MASH. If this MASH condition becomes more severe, the following problems can occur:

• MASH with liver fibrosis: Fibrosis is the formation of scar tissue in the liver. This scarring occurs when liver cells are damaged and try to repair themselves.
• MASH-related cirrhosis: Cirrhosis is a condition in which the liver becomes severely damaged and loses its ability to function. This is very serious and can be life-threatening.
• Liver cancer (Hepatocellular carcinoma): This is a type of liver cancer that can be caused by MASH.

MASLD can not only cause these liver-related problems, but it can also increase the risk of other serious illnesses. For example:

• Cancer: Types of cancer such as breast cancer and colorectal cancer.
• Cardiovascular disease: Diseases related to the heart and blood vessels.
• Diabetes: People who do not currently have diabetes can develop new diabetes.

How is MASLD diagnosed?

To find out for sure if you have MASLD, doctors usually do several blood tests and imaging tests. Sometimes, they may also need to take a small piece of the liver for testing (a liver biopsy).

Blood tests

The doctor may do several blood tests, such as:

• A1C test: This measures your average blood sugar levels over the past two to three months.
• Complete Blood Count (CBC): This checks the amounts and characteristics of the different types of cells in your blood.
• Comprehensive Metabolic Panel (CMP): This tests the levels of about 14 things in your blood, such as proteins and electrolytes.
• Lipid panel: This is a test for cardiovascular disease. It measures the levels of fat particles (cholesterol, triglycerides) in your blood.
• Liver function tests: These blood tests measure various substances (enzymes, proteins) produced by the liver to give an idea of ​​the health of the liver.

Imaging tests

Your doctor may do scans like these to check for signs of MASLD in your liver:

• FibroScan®: This scan can give you an idea of ​​the amount of fat and fibrosis that is deposited in your liver.
• Magnetic Resonance Elastography and Proton Density Fat Fraction (MRE-PDFF): This is also a special type of scan. It can very accurately measure the percentage of fat in the liver and the degree of fibrosis.

Biopsy

Very rarely, if your doctor suspects that your symptoms are caused by something other than MASLD, or if they need more information after a test such as a fibroscan, they may take a small piece of tissue from your liver (a liver biopsy) and examine it under a microscope.

How is MASLD treated?

When treating MASLD, the first focus is on weight loss . In addition, the underlying conditions that caused MASLD, such as diabetes, high cholesterol, and high blood pressure, are also treated.

In fact, losing weight can make a big difference to your liver health. Reducing excess fat in the liver can help control inflammation that can lead to conditions like cirrhosis. Your doctor may recommend a special diet plan, such as the Mediterranean diet or the DASH diet. We'll talk about these diets in a separate article.

Moderate exercise for at least 30 minutes a day, three days a week, can help you lose weight. Your doctor may tell you to lose 10% or more of your total body weight. However, even losing 3% to 5% of your body weight can make a big difference .

Weight loss medication

If you have diabetes and/or obesity, your doctor may prescribe weight loss medications, such as GLP-1 agonists. These medications lower your blood sugar levels and help you lose weight. Some examples are:

• Semaglutide (Semaglutide - Ozempic® or Wegovy®)
• Liraglutide (Liraglutide - Victoza® or Saxenda®)
• Tirzepatide (Mounjaro® or Zepbound®)

Bariatric surgery

Sometimes your doctor may also talk to you about bariatric surgery. If you are diagnosed with MASLD before cirrhosis develops, this weight loss surgery can reverse the condition.

Can the MASLD situation be reversed?

Yes, it can be done! But it depends on your situation. Generally, if you don't have MASH-related cirrhosis, treatment can reverse MASLD.

It is important to detect this disease early . This can help control the damage to the liver before it becomes too serious. Losing weight and making lifestyle changes can help reverse the damage to the liver caused by MASLD. However, this depends on your overall health. So, ask your doctor if losing weight can reverse your condition.

Can MASLD be prevented?

This condition often affects people who are obese and have type 2 diabetes. It may not be possible to completely prevent these conditions from developing. However, early detection and lifestyle changes can help prevent or control the development of MASLD.

If you are obese or have type 2 diabetes, your doctor may recommend blood tests and scans to check for signs of the condition. If caught early, you can make lifestyle changes to reduce your risk.

How long can you live with MASLD?

Research shows that having MASLD can affect your lifespan. For example, one study found that people with MASLD may live an average of 2.8 years less than those without the condition.

However, many factors affect how long you will live with MASLD. Your situation may be different from others. Therefore, your doctor is the best source of information about what you can expect.

How do I take care of myself?

If you have MASLD, the best way to take care of yourself is to work with your doctors to control the conditions that caused MASLD, such as excess weight, obesity, and type 2 diabetes. Losing weight and staying active can help reduce and possibly reverse liver damage. Here are some other suggestions:

• Be aware of your overall health. MASLD increases your risk of developing diabetes, heart disease, and some types of cancer. So, ask your family doctor about what tests you can do to reduce your risk.
• Develop habits that are good for your liver. Quit smoking and drinking alcohol. Smoking and alcohol put extra stress on your liver. Also ask your doctor about getting vaccinated against hepatitis A and hepatitis B.
• Don't give up, keep trying.

Losing weight takes time. You may not see a big difference right away, but you will see results gradually. Also, exercising regularly is a commitment. If you feel tired or bored during this journey, talk to your doctor about it.

When should I see a doctor?

If you notice any changes in your body, such as feeling more tired than usual or having pain in the upper right side of your abdomen, be sure to see your doctor . These changes may indicate a serious case of MASH, a condition of fatty liver disease that can progress to more serious conditions like cirrhosis and hepatocellular cancer.

Does alcohol use cause MASLD?

No, alcohol consumption does not directly cause MASLD. As we mentioned earlier, this was previously called non-alcoholic fatty liver disease (NAFLD). This means that this condition can develop even if you don't drink a lot of alcohol.

But, the most important thing is that if a person with MASLD consumes alcoholic beverages, they are at a much higher risk of developing cirrhosis than the average person. That's why doctors usually advise people with MASLD to avoid alcoholic beverages completely.

Finally, things to remember

If a blood test during your annual physical shows that you have a problem with your liver, further tests may be done to confirm that you have MASLD. This liver disease can lead to more serious problems if not managed properly.

But the good news is that lifestyle changes, such as losing weight and being active, can help prevent MASLD from getting worse. They can even reverse the damage to your liver. But losing weight and getting active isn’t something you can do overnight. It takes time and dedication. Some days, you may feel like you’re getting tired of these things. Your healthcare team understands the challenge of trying things that don’t seem to work right away. So, never hesitate to ask for help and support. Your liver is precious to you, and it’s up to you to take care of it!

` Liver fat, fatty liver, diabetes, obesity, cirrhosis, liver health