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Latest article: Metabolic dysfunction-associated steatotic liver disease: A rising health concern

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Table of Contents

  1. Diagnostic criteria
  2. Pathogenesis of MASLD
  3. Risk factors
  4. First line intervention: Diet and exercise
  5. Nutritional and herbal therapies
  6. Summary

In June 2023, a consensus statement on a new fatty liver disease nomenclature was published, effectively retiring the term nonalcoholic fatty liver disease (NAFLD) and introducing the term metabolic dysfunction-associated steatotic liver disease (MASLD).1 MASLD affects more than 30% of the population globally and is increasing in prevalence.2

Key highlights

  • 30% of the population are affected by MASLD.
  • Multi-factorial pathogenesis, likely via a “first hit” acquired from insulin resistance and hepatic steatosis due to excessive fatty acids, followed by a “second hit” involving oxidative stress, lipid peroxidation, inflammation, and subsequent fibrosis, which leads to ongoing damage in hepatocytes (Figure 2).
  • Associated with an elevated risk of cardiovascular diseases (CVDs).
  • Diet and exercise are first line intervention, e.g. weight loss of 5–7% can reduce liver steatosis in 65% of individuals with MASLD.
  • Herbal and nutritional therapies include choline, omega-3 fatty acids, probiotics and prebiotics, silymarin, vitamin D, vitamin E and garlic (Table 2).
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Table 1. Cardiometabolic risk factors associated with MASLD.

Diagnostic criteria

MASLD is defined as the presence of excess triglyceride storage in the liver detected by imaging or biopsy in conjunction with one or more cardiometabolic risk factors (Table 1). Other discernible causes, such as harmful alcohol intake, need to be absent.3

MASLD may be classified into two types: simple fatty liver and the more severe metabolic dysfunction-associated steatohepatitis (MASH)4 which can lead to cirrhosis and hepatocellular carcinoma (HCC). Figure 1 shows the development from a healthy liver to steatosis to MASH, which is still reversible.

Genetic, environmental factors and combined diseases can affect the occurrence and development of MASLD.5

Topics

DiabetesBiliary cirrhosisHypertensionInsulin resistanceInsulinCardiovascular diseaseType 2 diabetesNon alcoholic fatty liver diseaseMasldNafld