When most people think about liver problems and cirrhosis, they tend to think that alcohol is the most common reason for liver damage. However, did you know that fatty liver is actually the most common cause of liver disease in the world?
It is estimated that up to 30% of the US population may have fatty liver disease, which now goes by the name of metabolic dysfunction associated steatotic liver disease (MASLD). Most patients with it do not have associated liver inflammation, called hepatitis (not to be mistaken with viral hepatitis that most people are familiar with). Without inflammation, the fat in the liver can be harmless.
However, if left untreated, 5-10% of patients with MASLD will develop inflammation. This is termed MASH (metabolic dysfunction associated steatohepatitis). MASH may progress to scarring of the liver and ultimately cirrhosis and liver failure.
Risk factors for developing fatty liver/MASLD include the following:
· obesity
· high cholesterol
· insulin resistance
· type 2 diabetes
Most patients will not have any symptoms with MASLD, but if left untreated with progression to MASH, symptoms may develop and could include the following:
· pain in the upper right part of the abdomen where the liver is located
· fatigue
· weakness
· appetite loss
· swelling and fluid retention of the abdomen
· yellowing of the skin and eyes (called jaundice)
· elevated liver enzymes
Eventually, cirrhosis (scarring and hardening) of the liver may happen, which can then lead to liver failure or liver cancer.
Currently there is only one FDA approved medication (resmetirom) available for treatment, but it is new to the market, very expensive and only indicated for treatment in patients with moderate to advanced liver scarring. As such, it is important to get checked by your doctor to determine if you are at risk of MASLD before it progresses. By checking blood tests such as your blood count, liver enzymes, sugar, cholesterol, and A1C (the average of your blood sugar in the blood over the last 2-3 months), your doctor can make an assessment if you are at risk.
If you are at risk of or are diagnosed with MASLD, other tests, such as a test called a Fibroscan (an ultrasound to determine liver scarring), elastography (performed with ultrasound or MRI), or liver biopsy may be recommended for further evaluation.
Other than the one medication previously mentioned, there are no prescriptions that are known to effectively treat the condition. The best management remains early detection and initiation of lifestyle modification, which includes weight loss, management of high cholesterol and high sugar, and completely stopping alcohol use. A low carbohydrate/low glycemic diet may result in the greatest reduction of liver fat compared to other diets.
So if you struggle with being overweight or have health conditions such as high cholesterol and diabetes, be sure to talk to your doctor about your risk of fatty liver/MASLD.
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