08/26/2025
MASLD
By: Geetanjali kale, M.D
When you say MASLD to a non-medical person, the first question they ask, is why would you name something that? What does it even stand for? I hear the exasperation in their tone. Our medical community can certainly work on more patient friendly names for diseases! But I am bringing it up today because of how important it is to know about this disease process, as we are experiencing metabolic syndrome and its complication at epidemic proportions.
We are diagnosing variety of presentations stemming from underlying metabolic dysfunction, diagnosed at younger and younger ages and MASLD is certainly a very important metabolic dysfunction, patients should be aware of.
What is MASLD? (Metabolic dysfunction Associated Steatotic Liver Disease) MASLD also simply known as ‘fatty liver’ is fat deposition in liver associated with one or more risk factor of metabolic dysfunction, (HTN, dyslipidemia, diabetes or prediabetes, OSA, obesity), in absence of any other explanation for liver disease such as alcohol use or hepatitis.
When to suspect if you have this condition?
Liver function test abnormalities are early clues. Sometimes labs such as ALT, AST are mildly elevated, sometimes elevated in multiple times the normal value. In some cases of MASLD, liver tests can be completely normal. If your doctor suspects it strongly, if you have more than 2 metabolic risk factors, you can proceed with Liver Ultrasonography even in presence of normal liver function tests. The liver ultrasound can be followed up with further testing such as Fibroscan imaging (assessing elasticity of liver parenchyma) or liver biopsy.
Why is it important to diagnose MASLD at earlier stages?
MASLD is linked to underlying metabolic dysfunction and underlying hepatic insulin resistance. MASLD causes diffuse fat infiltration in your liver cells, that can then elicit fibrosis or scar formation, replacing healthy liver tissue into scar tissue. This leads to cirrhosis and significant loss of normal liver function.
When diagnosed at earlier stages, we can reverse this damage by improving components of metabolic syndrome such as diabetes, hypertension, dyslipidemia obesity.
While working on lifestyle modifications, your physician can consider drugs such as metformin, GLP-1 agonists, GLP-1/GIP agonists, oral weight loss medications etc. There is a medication by the name Resmetirom (Rezdiffra) is specifically approved for management of MASLD. Some patients may benefit from bariatric surgical interventions to improve their risk of hepatic fibrosis.
Next time when your doctor see your physician and you discuss other metabolic conditions such as type 2 diabetes, and hypertension, dyslipidemia, OSA, obesity, please feel free to ask any additional questions you may have regarding this funnily named entity called MASLD as well.
