Metabolic dysfunction–associated steatotic liver disease
Excessive fat buildup in the liver with other metabolic disease / From Wikipedia, the free encyclopedia
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Metabolic dysfunction–associated steatotic liver disease (MASLD) is the name adopted in 2023 for the condition previously known as non-alcoholic fatty liver disease (NAFLD).[lower-alpha 1] This condition is diagnosed when there is excessive fat build-up in the liver (hepatic steatosis), and at least one metabolic risk factor.[1][3][4] When there is also moderate alcohol use, the term MetALD is used, and these are differentiated from alcoholic liver disease (ALD) when this is the sole cause of steatotic liver disease.[1][12] The terms non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH, now MASH) have been used to describe different severities, the latter indicating the presence of further liver inflammation.[4][5][8] NAFL is less dangerous than NASH and usually does not progress to it,[4] but this progression may eventually lead to complications, such as cirrhosis, liver cancer, liver failure, and cardiovascular disease.[4][13]
Parts of this article (those related to the new 2023 nomenclature and classification) need to be updated. (November 2023) |
Metabolic dysfunction–associated steatotic liver disease | |
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Other names | MASLD, Non-alcoholic fatty liver disease (NAFLD),[1] Metabolic (dysfunction) associated fatty liver disease, MAFLD[2] |
Stages of metabolic dysfunction–associated steatotic liver disease, progressing from healthy, to steatosis (fat accumulation), inflammation, fibrosis and cirrhosis. | |
Specialty | Hepatology |
Symptoms | Asymptomatic in the early stages In later stages: * Deposits of cholesterol on the eye lids * Fatigue * Crusty red nodules * Digestive issues Lastly causes liver disease and eventually liver failure |
Complications | Cirrhosis, liver cancer, liver failure, cardiovascular disease[3][4] |
Duration | Long term |
Types | Metabolic dysfunction–associated steatotic liver (MASL), Metabolic dysfunction-associated steatohepatitis (MASH)[4][5] |
Causes | Genetic, environmental |
Risk factors | Obesity, metabolic syndrome, type 2 diabetes mellitus, liver disease |
Diagnostic method | Ultrasound, Coexisting metabolic disorders, Liver biopsy |
Treatment | Weight loss (in case of obesity) Dietary reduction of fructose and glucose[6] (diet and exercise)[4][7] |
Prognosis | Depends on type[8] |
Frequency | 24% in worldwide population, 80% in obese, 20% in normal-weight |
Deaths | MASH: 2.6% risk of death per year[5] MAFL: Unknown[9] |
Obesity and type 2 diabetes are strong risk factors for MASLD.[7] Other risks include being overweight, metabolic syndrome (defined as at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum HDL cholesterol), a diet high in fructose, and older age.[4][8] Obtaining a sample of the liver after excluding other potential causes of fatty liver can confirm the diagnosis.[3][7][8]
Treatment for MASLD is weight loss by dietary changes and exercise;[5][14][15] bariatric surgery can improve or resolve severe cases.[14][16] Although no drugs are approved to treat MASLD,[17] there is some evidence for GLP-1 agonists, pioglitazone, and vitamin E.[18] Those with MASH have a 2.6% increased risk of dying per year.[5]
MASLD is the most common liver disorder in the world; about 25% of people have it.[19] It is very common in developed nations, such as the United States, and affected about 75 to 100 million Americans in 2017.[20][21][22][23] Over 90% of obese, 60% of diabetic, and up to 20% of normal-weight people develop MASLD.[24][25] MASLD was the leading cause of chronic liver disease[23][24] and the second most common reason for liver transplantation in the United States and Europe in 2017.[14] MASLD affects about 20 to 25% of people in Europe.[16] In the United States, estimates suggest that 30% to 40% of adults have MASLD, and about 3% to 12% of adults have MASH.[4] The annual economic burden was about US$103 billion in the United States in 2016.[24]