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Contributed by: Adrian S. Lindsey, MD | Gastroenterologist

Recently, liver disease experts from around the world met and decided to re-classify a condition called “fatty liver disease,” feeling that the language was too shaming, nondescriptive and stigmatizing. But keeping your liver healthy remains important.

New name: steatotic liver disease

This is the umbrella term for conditions that happen when fat builds up in your liver. There are two main types:

  1. Alcohol-associated liver disease. Heavy alcohol use causes this type.
  2. Non-alcoholic fatty liver disease. This type is now known as metabolic dysfunction-associated steatotic liver disease, or MASLD. If you have MASLD, something other than drinking too much caused fat to build up in your liver.

There are two subtypes of MASLD:

  • MASL, or metabolic dysfunction-associated steatotic liver. With this type, the fat in your liver has not yet caused any liver damage.
  • MASH, or metabolic dysfunction-associated steatohepatitis. With this type, damage has occurred, and if not treated can lead to cirrhosis, which is permanent liver damage that can in turn lead to liver failure or liver cancer.

Who is at risk?

Though MASLD is the most common type of chronic liver disease, experts aren’t fully sure what causes it. It’s believed that your genes, diet (especially high-fructose intake), and underlying insulin resistance or metabolic syndrome may all play a role.

You’re more likely to develop MASLD if you experience obesity, Type 2 diabetes, high cholesterol, hypertension or cardiovascular disease. It’s called a “silent” disease because most often people have few or no symptoms.

Screening for MASLD

Screening for MASH should be targeted to individuals with hepatic steatosis (which can be seen on imaging) and at least one cardiometabolic risk factor: particularly those with Type 2 diabetes, prediabetes, obesity with metabolic complications, a family history of cirrhosis, or more than mild alcohol consumption.

How do healthcare providers diagnose steatotic liver disease?

Your healthcare provider may first suspect you have steatotic liver disease after blood tests at a routine checkup. They may show increased or high levels of two liver enzymes called ALT (alanine aminotransferase), or AST (aspartate aminotransferase). If those levels are not in a normal range, your provider might order additional tests to rule out conditions that also increase these liver enzymes, as well as review your medical history and ask questions about lifestyle risks, such as diet and exercise habits and alcohol use.

Treatments for MAFLD

There’s no quick fix or medication to treat MAFLD but losing even a small amount of weight is usually recommended. Research finds losing at least 3% to 5% of your body weight can reduce fat in your liver. To reduce liver fibrosis and inflammation, you may need to lose up to 10%.

Eating a healthy diet such as the Mediterranean-style diet (caloric deficit, high fiber, unsaturated fats, limited carbohydrates and saturated fats) and exercise provide additional benefits independent of weight loss, with at least 150 minutes per week of moderate-intensity activity recommended.

At this time, there is only one FDA-approved medication to treat MASH: Resimditeron or Resdiffra. There are studies for other medications that will likely be approved in the near future.

You may be able to prevent MAFLD if you:

  • Maintain a healthy weight.
  • Follow a healthy diet.
  • Limit portion sizes.
  • Get regular physical activity. Even without weight loss, this can improve your liver health.
  • Limit alcohol use.

Experiencing Symptoms?

Make an appointment with a primary care provider to get a handle on your health. To schedule, call 216-My-Metro (216-696-3876) or visit metrohealth.org/appointments.

Need more information? The Hepatitis C and Liver Clinic at MetroHealth specializes in caring for people with liver problems, including steototic liver disease. We provide the most advanced tools and care under one roof. We offer evaluations, imaging including FibroScan, nutritional support, and preventive health.

BONUS RECIPE: Sunflower Slaw
Including nuts and seeds in your diet can help protect against fatty liver disease. Try this vinegar-based coleslaw with sunflower seeds for a tasty side dish to your summer meals.