Condition
Fatty Liver Disease (MASLD)
MASLD describes excess fat in the liver in the presence of at least one cardiometabolic risk factor and in the absence of other identifiable causes. A 2023 multisociety consensus renamed NAFLD to MASLD.
The spectrum
- MASLD (steatosis): excess hepatic fat without significant inflammation.
- MASH (steatohepatitis): steatosis plus hepatocyte injury and inflammation.
- Fibrosis: scarring of the liver, ranging from mild to advanced.
- Cirrhosis: end-stage fibrosis with architectural distortion and risk of complications.
Diagnosis
Initial assessment typically includes liver enzymes, noninvasive fibrosis scoring (e.g., FIB-4), imaging (ultrasound, transient elastography), and, when indicated, biopsy. Many people with MASLD have normal ALT.
Why it matters
MASLD is closely linked to insulin resistance and metabolic syndrome and independently increases cardiovascular risk. Identification of advanced fibrosis is the strongest prognostic marker for liver-related outcomes.
Management context
Foundations of care include weight loss (a sustained loss of approximately 5–10% body weight has been associated with reductions in steatosis and inflammation), control of diabetes and lipids, limiting alcohol, and treating sleep apnea. New pharmacologic options for MASH are an active area of regulatory and research activity.