Are you keeping your liver healthy? The liver is an important part of your body, performing hundreds of functions every day. It regulates your blood sugar and fat, processes nutrients, and it stores vitamins and minerals, just to name a few of the liver’s vital jobs.
MASLD and MASH, sometimes known as fatty liver disease, are becoming increasingly common so we asked our Gastroenterology (GI) Clinic and a Registered Dietitian Nutritionist with our Lifestyle Medicine Clinic about what people should know about this type of liver disease.
What is MASLD?
Metabolic dysfunction-associated steatotic liver disease, or MASLD, is a condition where fat builds up in the liver. MASLD used to be called fatty liver disease or nonalcoholic fatty liver disease.
When MASLD progresses, the liver has fat buildup and becomes inflamed, the condition is called metabolic dysfunction-associated steatohepatitis, or MASH. MASH used to be called nonalcoholic steatohepatitis.
If left untreated, over time the inflammation from MASH can cause scarring on your liver known as cirrhosis. Cirrhosis is a very serious and advanced disease; it can increase the risk of liver cancer and liver failure. Luckily, scar tissue can be detected before reaching cirrhosis which is very important in preventing liver disease from reaching this stage.
What Causes MASLD?
The causes of MASLD are not well studied, but it is impacted by a combination of factors including genetics, metabolism, nutrition, and amount of physical activity. It has been found to be related to a variety of other health conditions, which makes them risk factors for developing MASLD later on.
Risk factors that could increase your likelihood of MASLD include:
- Extra weight, especially when weight is carried in the middle of your waist
- Insulin resistance
- Prediabetes and type 2 diabetes
- High blood sugar (triglycerides)
- High cholesterol
- High blood pressure
- Physical inactivity
- Genetics
- Metabolic syndrome
What are the Symptoms of MASLD?
Sometimes MASLD and MASH are called silent liver diseases because many people with these diagnoses have no symptoms. When someone has MASLD they may experience symptoms like:
- Feeling tired or unwell
- Discomfort or pain in the upper right belly
If your disease has progressed to MASH it can also cause symptoms such as:
- Swelling in the legs
- Itchy skin
- Trouble breathing
- Yellowing of the skin and eyes (jaundice)
How is MASLD Diagnosed?
Your primary care provider might suspect you have MASLD or MASH based on the results of your routine blood tests. MASLD is diagnosed by ruling out other possible diseases. Based on your blood test results, your primary care provider might decide you are at risk of progressing or having advanced disease and at that point they will refer you to a specialist.
You may get more specific blood tests or scan to further confirm your liver function and stage of disease. When someone has MASLD, their blood will have more liver enzymes than normal. If you have more advanced liver disease and cirrhosis, your blood work may show lower platelets and albumin levels.
How is MASLD Treated? Is it Permanent?
While prevention is the best plan, MASLD can be reversed! If MASLD is diagnosed early, many people can significantly reduce liver fat and improve liver inflammation and scarring (fibrosis) by making long-term lifestyle changes.
If someone is overweight or obese, even a modest amount of sustained weight loss can improve liver health. However, weight loss isn’t the only goal. Regular physical activity and improvements in diet quality can have a substantial impact on liver health even when a person does not lose weight.
The goal is to make lasting changes rather than a “quick fix.”
Long-term healthy lifestyle changes to manage and reverse MASLD include:
- Avoiding alcohol – Alcohol can make liver problems worse.
- Eating a healthy diet – Avoid sugary and highly processed foods and eat plenty of vegetables, fruits, and whole grains (more on this in the next section)
- Getting regular physical activity – Even gentle activity, like walking, is good for your health.
- Losing weight (when needed)
- Managing your blood pressure and blood sugar (your provider may refer to these as comorbidities)
- Going to all your doctor’s appointments
For those with advanced disease (MASH), there are two FDA approved medications that are very effective at reducing scarring and the amount of fat on your liver. This might come as a daily pill or a shot you give yourself each day. You must be seen a gastroenterologist to assess the amount of scar tissue on your liver before starting medication. The gastroenterologist will also help monitor your progress on the medication over time.
If I Have MASLD, What Kinds of Food Should I Eat? Are There Foods I Should Avoid?
There isn’t a specific “MASLD diet.” What we encourage is a balanced eating pattern with lots of minimally processed foods.
Some good choices include:
- Plenty of vegetables and whole fruits
- Beans, lentils and other high-fiber foods
- Whole grains such as oats and barley
- Fish and seafood
- Lean proteins and plant proteins, like tofu
- Nuts and seeds
- Avocado and olive oil
- Lower-fat or unsweetened dairy products, when appropriate
Things to avoid include:
- Extra carbohydrates
- Highly processed foods
- Foods with high saturated fat
Rather than focusing on completely skipping certain foods, Valley’s dietitians encourage people to look at their overall eating habits. For example, replacing sugary beverages with water, choosing whole grains more often, and replacing processed meat with fish, beans, or other lean proteins can make a meaningful difference.
Alcohol is also important to discuss with your healthcare provider because it can contribute to liver injury, particularly in people who already have liver disease.
Anything Else People Should Know About MASLD?
Prevention is the best way to avoid advanced disease, but should you find yourself needing treatment for MASLD, your care team may include both your PCP and a GI specialist to help you monitor your disease progression and hopefully find ways of maintaining and/or improving your liver health.
Working with a dietitian can also be helpful if you find yourself diagnosed with MASLD!
A dietitian can help turn general recommendations into a customized plan that focuses on your needs, preferences, culture, lifestyle, and health goals. They help identify practical changes that are realistic and sustainable. This can include improving fiber intake, improving quality or amount of carbohydrates and fats, reducing added sugars, balancing meals, and addressing portion sizes when appropriate.
A dietitian can also help you address other conditions that commonly occur alongside MASLD, like prediabetes, diabetes, high cholesterol, high blood sugar, and high blood pressure. Most importantly, nutrition counseling doesn’t mean completely changing the way you eat. Small, consistent changes can add up to meaningful improvements in metabolic and liver health.
—
You can learn more about MASLD/MASH on our health library.
Content for this article is for educational purposes only and is not a substitute for professional medical advice.
