Metabolic dysfunction–associated steatotic liver disease
Excessive fat buildup in the liver with other metabolic disease / From Wikipedia, the free encyclopedia
Metabolic dysfunction–associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD),[lower-alpha 1] is a type of chronic liver disease. This condition is diagnosed when there is excessive fat build-up in the liver (hepatic steatosis), and at least one metabolic risk factor.[1][3][4] When there is also increased alcohol intake, the term MetALD, or metabolic dysfunction and alcohol associated/related liver disease is used, and differentiated from alcohol-related liver disease (ALD) where alcohol is the predominant cause of the steatotic liver disease.[1][12] The terms non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH, now MASH) have been used to describe different severities, the latter indicating the presence of further liver inflammation.[4][5][8] NAFL is less dangerous than NASH and usually does not progress to it,[4] but this progression may eventually lead to complications, such as cirrhosis, liver cancer, liver failure, and cardiovascular disease.[4][13]
Parts of this article (those related to the new 2023 nomenclature and classification) need to be updated. (November 2023) |
Metabolic dysfunction–associated steatotic liver disease | |
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Other names | MASLD, Non-alcoholic fatty liver disease (NAFLD),[1] Metabolic (dysfunction) associated fatty liver disease (MAFLD)[2] |
Stages of metabolic dysfunction–associated steatotic liver disease, progressing from healthy, to steatosis (fat accumulation), inflammation, fibrosis and cirrhosis. | |
Specialty | Hepatology |
Symptoms | Asymptomatic in the early stages In later stages: * Deposits of cholesterol on the eye lids * Fatigue * Crusty red nodules * Digestive issues Lastly causes liver disease and eventually liver failure |
Complications | Cirrhosis, liver cancer, liver failure, cardiovascular disease[3][4] |
Duration | Long term |
Types | Metabolic dysfunction–associated steatotic liver (MASL), Metabolic dysfunction-associated steatohepatitis (MASH)[4][5] |
Causes | Genetic, environmental |
Risk factors | Obesity, metabolic syndrome, type 2 diabetes mellitus, liver disease |
Diagnostic method | Ultrasound, Coexisting metabolic disorders, Liver biopsy |
Treatment | Weight loss (in case of obesity) Dietary reduction of fructose and glucose[6] (diet and exercise)[4][7] |
Prognosis | Depends on type[8] |
Frequency | 24% in worldwide population, 80% in obese, 20% in normal-weight |
Deaths | MASH: 2.6% risk of death per year[5] MAFL: Unknown[9] |
Obesity and type 2 diabetes are strong risk factors for MASLD.[7] Other risks include being overweight, metabolic syndrome (defined as at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum HDL cholesterol), a diet high in fructose, and older age.[4][8] Obtaining a sample of the liver after excluding other potential causes of fatty liver can confirm the diagnosis.[3][7][8]
Treatment for MASLD is weight loss by dietary changes and exercise;[5][14][15] bariatric surgery can improve or resolve severe cases.[14][16] There is some evidence for SGLT-2 inhibitors, GLP-1 agonists, pioglitazone, and vitamin E in the treatment of MASLD.[17][18] In March 2024, resmetirom was the first drug approved by the FDA for MASH.[19] Those with MASH have a 2.6% increased risk of dying per year.[5]
MASLD is the most common liver disorder in the world; about 25% of people have it.[20] It is very common in developed nations, such as the United States, and affected about 75 to 100 million Americans in 2017.[21][22][23][24] Over 90% of obese, 60% of diabetic, and up to 20% of normal-weight people develop MASLD.[25][26] MASLD was the leading cause of chronic liver disease[24][25] and the second most common reason for liver transplantation in the United States and Europe in 2017.[14] MASLD affects about 20 to 25% of people in Europe.[16] In the United States, estimates suggest that 30% to 40% of adults have MASLD, and about 3% to 12% of adults have MASH.[4] The annual economic burden was about US$103 billion in the United States in 2016.[25]