What is fatty liver disease?
Metabolic dysfunction-associated liver disease, MASLD (Nonalcoholic fatty liver disease or NAFLD) is caused by excess fat that accumulates in the liver. MASLD is like alcoholic liver disease but can happen in people who rarely or never drink. Now, there is a new term called Met-ALD to describe people with steatotic (fatty) liver disease who drink moderate amounts of alcohol. Fatty/steatotic liver disease is a worldwide epidemic occurring in 1 out of 4 adults. It is the most common cause of liver disease and the number 2 cause for liver transplantation. Up to 30% of people with MASLD/NAFLD progress to MASH/NASH. When this happens, liver cells become injured and inflamed and form scarring known as fibrosis. Fibrosis leads to cirrhosis and increases the risk for liver cancer.
Risk factors for fatty liver disease progression to liver cirrhosis include:
- Obesity
- Hypothyroidism
- High body fat
- Increased belly fat (apple shape body habitus)
- Metabolic syndrome
- Diabetes
- Prediabetes
- Polycystic ovary syndrome (PCOS)
- Cushing’s Syndrome
- Age >50 years
- High blood pressure (Hypertension)
- Low HDL (good) cholesterol
- High triglycerides
- Atherogenic metabolic dyslipidemia
- Psoriasis
- Obstructive sleep apnea
- Pituitary disease
- Low testosterone (male hypogonadism)
- Genetic factors (PNPLA3)
What are the symptoms of steatotic/fatty liver disease?
MASLD/NAFLD is often a silent disease with few or no symptoms. MASLD/NAFLD can cause fatigue which may be overlooked during a medical evaluation for tiredness. Other symptoms include nausea, yellowing of the eyes or discomfort in the upper right side of the abdomen.
How is steatotic/fatty liver disease diagnosed?
MASLD/NAFLD is suspected by abnormal liver tests, primarily elevated liver enzymes (AST - aspartate aminotransferase, ALT - alanine aminotransferase), high ferritin or low platelets. Suspected MASLD/NAFLD is then confirmed with an imaging study such as ultrasound, CT or MRI of the abdomen. Traditionally, the diagnosis of MASH/NASH has been made by liver biopsy, but this can be painful and expensive. New noninvasive tools such as the ELF (enhanced liver fibrosis) test have become another way to detect fibrosis and assess the risk for progression to advanced liver disease.
How is steatotic/fatty liver disease treated?
The management of MASLD/NAFLD consists of treating liver disease alongside the associated metabolic conditions such as obesity, diabetes and abnormal cholesterol. Weight loss with a diet plan is one of the most effective treatments for MASLD/NAFLD while improving all the metabolic conditions and decreasing the risk of heart disease. Several dietary approaches to MASLD/NAFLD have been shown to be effective including fast weight loss programs. Although there are no approved drug therapies for NAFLD, several diabetes medications (such as tirzepatide - Mounjaro or semaglutide – Ozempic, Wegovy, Rybelsus) have been shown to be effective. Weight loss medications are also beneficial for MASLD/NAFLD although there is very little research. A type of weight loss surgery known as metabolic surgery is an effective treatment. New pharmaceutical agents that directly target MASH/NASH are in clinical trials. Liver transplantation is also a treatment for patients with end stage liver disease.
Medications for weight loss:
- phentermine (Adipex-P, Lomaira)
- phendimetrazine (Bontril)
- benzphetamine (Regimex, Didrex)
- orlistat (Xenical, alli)
- phentermine and topiramate ER (Qsymia)
- Plenity
- naltrexone HCl and bupropion HCl (CONTRAVE)
- liraglutide injection (Saxenda)
- semaglutide injection (wegovy)
- Tirzepatide (Mounjaro) (approved to treat diabetes)
Weight loss is not about willpower. To lose weight and keep it off for good, you must address your body's biochemistry.
