What comes to your mind when you hear ‘liver disease’?
Most people would think of heavy drinkers or those with a history of viral hepatitis. But what about those who rarely, if ever, drink alcohol? Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), previously called Non-Alcoholic Fatty Liver Disease (NAFLD), is an under-recognised condition rapidly becoming a global health crisis, currently estimated to affect around 38% of the world’s population.
Commonly linked to obesity and poor metabolic health, MASLD can develop silently without symptoms, progressing to severe complications like liver failure or cancer if left untreated. Dr Thaninee Prasoppokakorn, a gastroenterologist and hepatologist at MedPark Hospital Bangkok, shares why everyone, not just those with high-risk habits, needs to be aware of this condition.
What is MASLD?
MASLD, is a condition characterised by excessive fat accumulation in the liver, where fat accounts for more than 5 to 10% of the liver’s weight.
If untreated, MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH), involving liver inflammation and damage. This can lead to scarring (liver fibrosis), cirrhosis, or even liver cancer.
MASLD can also increase your risk of heart problems (cardiovascular diseases). “The same metabolic dysfunction that causes fat build up affects the cardiovascular system, heightening the risk of heart disease and stroke,” Dr Thaninee explains.
Why the new terms?
The newer terms, MASLD and MASH, better reflect the root cause: metabolic dysfunction. Unlike the old term “non-alcoholic,” these names clarify the mechanisms underlying the disease and reduce the stigma associated with the word “fatty.”
“This terminology shift emphasises metabolic abnormalities as the key driver and also accommodates people with low alcohol consumption or other coexisting conditions,” Dr Thaninee notes.
What causes MASLD?
Several factors contribute significantly to the development of MASLD:
- Obesity: Visceral fat accumulation releases free fatty acids, overwhelming the liver’s capacity to process them. Obesity is also closely associated with insulin resistance, which further promotes fat buildup in the liver.
- Dyslipidemia: Abnormal levels of cholesterol or triglycerides in the blood contribute to excessive fat deposition in the liver.
- Gut Microbiome Alterations: Changes in the composition of gut bacteria can lead to increased liver inflammation and fat accumulation.
- Genetics: Variations in the PNPLA3 gene significantly elevate the risk of MASLD by impairing the breakdown of triglycerides in the liver. This same variant has also been linked to an increased risk of Hepatocellular Carcinoma (HCC), especially in individuals with advanced MASLD or liver fibrosis.
Interestingly, MASLD can also develop in individuals who do not exhibit these common risk factors. However, without timely intervention, MASLD can progress to more severe conditions, including MASH, liver fibrosis, cirrhosis, and HCC.
Who’s at risk?
MASLD doesn’t discriminate, affecting children and adults alike. However, it’s more common in:
- Middle-aged adults with obesity, excess belly fat, type 2 diabetes, or dyslipidemia
- Individuals with metabolic syndrome (a combination of the above issues)
- Those with certain genetic predispositions.
What are the symptoms of MASLD?
MASLD is often referred to as a silent condition because most people show no symptoms in its early stages. “MASLD is usually discovered during routine check-ups or imaging for unrelated issues,” Dr Thaninee explains.
As the disease progresses, symptoms may include:
- Fatigue
- Unexplained weight gain
- Discomfort in the upper right abdomen
In advanced stages, signs like jaundice or swelling may appear, indicating severe liver damage.
This is why regular health check-ups are crucial for early detection, whether you are at risk or not.
How is MASLD Diagnosed?
Diagnosing MASLD involves two steps:
- Identifying liver fat accumulation through imaging or other diagnostic methods.
- Evaluating metabolic dysfunction, such as BMI, waist circumference, or conditions like diabetes, hypertension, and dyslipidemia.
MedPark Hospital Bangkok uses the following diagnostic tools to confirm the diagnosis and evaluate the severity of MASLD:
- Blood tests: Detect elevated liver enzymes, abnormal lipid profiles, or glucose levels.
- Imaging techniques:
- Ultrasonography is commonly used to detect fatty liver.
- Advanced imaging like CT scans, MRI, or FibroScan provides more precise information on liver fat deposition.
- FibroScan (Transient Elastography): a non-invasive and highly advanced technique that offers both diagnostic and prognostic benefits. It measures:
- Liver Fat: Quantitatively assesses fat accumulation (steatosis).
- Liver Stiffness: Evaluates the degree of fibrosis or scarring in the liver.
FibroScan is particularly valued for its accuracy, ease of use, and ability to monitor disease progression or response to treatment without requiring invasive procedures like a liver biopsy.
- Liver biopsy: Reserved for complex cases, this invasive method confirms fat accumulation and assesses fibrosis or cirrhosis.
What are the Treatment Options for MASLD?
While MASLD can seem overwhelming, early detection allows for effective management.
1. Lifestyle modification: The cornerstone of treatment
- Weight loss is key: Losing 7 to 10% of body weight can improve liver health, reducing fat accumulation, and reducing stage of liver fibrosis.
- Dietary changes and regular exercise are essential.
- For severe cases, weight-loss medications or bariatric surgery may be recommended under medical supervision.
2. Multidisciplinary care
MedPark Hospital provides a team of hepatologists, endocrinologists, dietitians, and fitness specialists to create tailored treatment plans.
3. Medications
- Vitamin E and pioglitazone reduce liver inflammation.
- GLP-1 receptor agonists help with weight loss and improve liver inflammation and fibrosis.
Dr Thaninee shared a success story: “A middle-aged patient with obesity and early-stage MASH lost 10% of his weight through our program. His liver function normalised, and fibrosis regressed within a year.”
Prevention is always better than care
Preventing MASLD starts with maintaining a healthy weight, eating a balanced diet, and exercising regularly. Those with risk factors, like obesity or diabetes, should schedule regular check-ups for early detection.
“If you’re concerned about your liver health, early detection can make all the difference,” Dr Thaninee emphasises.
For more information or to book an appointment, visit MedPark Hospital’s website or complete the form below.
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