MASLD, previously known as non-alcoholic fatty liver disease, is a condition where fat accumulates in liver cells (hepatocytes) in the form of triglycerides. This accumulation is visible under a microscope. The term “non-alcoholic” was used to differentiate it from alcohol-related liver disease, which shows similar features.
The name change to MASLD aims to reduce stigma, emphasize the underlying pathophysiology (steatosis), and acknowledge that individuals can have both metabolic and alcohol-related liver disease.
In MASLD, the liver accumulates more fat than it can process, leading to liver cell damage and scarring. Mild MASLD, also known as simple steatosis, is quite common, affecting 30-35% of Australians. However, 10-40% of these cases may progress to steatotic hepatitis (MASH), and 15-25% of those may develop cirrhosis, an irreversible liver disease that is becoming a leading cause for liver transplants.
Risk factors for MASLD include obesity, insulin resistance, diabetes, diets high in saturated fats and ultra-processed foods, and a sedentary lifestyle. Other complex factors such as certain medications, genetics, gut microbiome, vitamin deficiencies, and mitochondrial function also play a role in the progression of liver disease.
Liver function abnormalities due to MASLD are often dismissed as insignificant, similar to pre-diabetes or mild type 2 diabetes. However, common does not mean low risk. MASLD can progress to end-stage liver disease, increase the risk of certain cancers, and heart disease.
Everyone with MASLD should have their FIB-4 score calculated. This score, based on liver tests, age, and platelet count, helps determine the likelihood of liver scarring and whether a special fibroscan and consultation with a gastroenterologist are needed.
Even mild or low-risk MASLD indicates metabolic dysfunction and should be monitored or reversed. Regular FIB-4 assessments every 1-2 years are recommended. Increasing vegetable intake, reducing saturated fat, losing weight, and increasing physical activity can help reverse MASLD.