### Understanding MASLD and Its Management Metabolic dysfunction–associated steatotic liver disease (MASLD) is a condition where fat accumulates in the liver due to abnormal metabolism. This chronic liver disease affects nearly 1 in 4 people in the United States. While it's normal for the liver to contain some fat, more than 5% is considered abnormal and is termed fatty liver or hepatic steatosis. Previously known as nonalcoholic fatty liver disease (NAFLD), MASLD was renamed in 2023 to better reflect its causes and avoid stigmatizing those affected. When inflammation and liver cell damage occur along with fat in the liver, it is called metabolic dysfunction-associated steatohepatitis (MASH). MASH is a more severe form of MASLD and can lead to cirrhosis and liver cancer if untreated. By 2030, MASH may become the leading cause of liver transplants in the U.S. ### Risk Factors MASLD is primarily associated with metabolic syndrome, which includes obesity, high cholesterol, high blood pressure, high blood sugar, and a large waistline. These conditions increase the risk of developing MASLD. Many people with MASLD do not show symptoms, but if present, they are often nonspecific, such as fatigue. ### Diagnosis and Management MASLD is often discovered through routine blood tests that check liver function. If abnormalities are found, imaging studies like ultrasound, CT scans, or MRIs may be conducted. A Fibroscan device may also be used to estimate fat and scarring in the liver. Managing MASLD involves reducing fat buildup in the liver. Key recommendations include: - **Losing weight** - **Dietary changes** - **Regular exercise** - **Eliminating alcohol** The FDA has approved a medication called Rezdiffra (resmetirom) for treating MASH in adults with moderate to advanced liver scarring. Weight loss drugs like semaglutide (Rybelsus, Ozempic) may also be helpful. In severe cases, bariatric surgery or endoscopic procedures like sleeve gastrectomy may be recommended. ### Health Implications MASLD doubles the risk of death and cardiovascular events like heart attacks. It also increases the likelihood of developing other conditions such as diabetes, high blood pressure, and dyslipidemia. If MASLD progresses to MASH, it can lead to cirrhosis, liver failure, and liver cancer. Heart disease is the leading cause of death for people with MASLD. By making lifestyle changes and following medical advice, individuals can manage MASLD and reduce its health risks.