Dr. Alexis G. McCary is a board-certified gastroenterologist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Largo Medical Center.
It’s a condition many people haven’t heard a lot about, but it is front of mind for many gastroenterologists: the buildup of fat in the liver, also known as fatty liver disease.
There are several causes of fat buildup in the liver, including viral hepatitis, certain medications, alcohol, and metabolic syndrome.
The metabolic syndrome is a group of conditions — high blood pressure, high blood sugar, obesity, and abnormal cholesterol levels — that increases the risk for heart disease and fatty liver. Because the number of people with metabolic syndrome is increasing in the United States, more and more people are diagnosed with fatty liver every year.
In fact, some estimates predict that by the turn of the decade, more than one third of the population will have non-alcoholic fatty liver disease. With so many people affected, I encourage people to learn more about metabolic syndrome that causes fatty liver. Here are seven things to know:
1. Fatty liver disease related to the metabolic syndrome recently got a new name. It’s metabolic dysfunction-associated steatotic liver disease or MASLD. This new name emphasizes that to be diagnosed with this condition, a patient must have liver steatosis, accumulation of fat in the liver, as well as a feature of the metabolic syndrome. The term steatotic was chosen because of the stigma associated with the word “fatty.”
2. One of the challenging aspects of metabolic dysfunction-associated steatotic liver disease is that most people don’t have any symptoms. Instead, when people undergo imaging, such as a CT scan or ultrasound, for another health concern, we may find the liver shows fat. Likewise, someone undergoing blood tests for another health concern may have abnormal liver function or liver enzyme results, another red flag for MASLD.
3. Everyone should try to prevent developing MASLD by living a healthy lifestyle through diet and exercise. That means you need to eat nutritious foods and control your weight. Keep blood pressure at normal levels. Avoid foods high in fat, cholesterol, and sugar. Avoid alcohol. Those with Type 2 diabetes, the most common form of diabetes, should aim to keep their blood sugar levels within healthy ranges every day. Exercise regularly: Aim for 30 minutes of moderate-intensity activity at least five times a week.
4. Treating MASLD focuses not on medications but on living a healthy lifestyle. Unfortunately, the U.S. Food and Drug Administration hasn’t approved any medications to treat MASLD, although research continues, and we hope medications are approved in the coming years. When I see patients with MASLD, I talk to them about managing any associated conditions they may have, such as diabetes or high cholesterol. (Medications can help manage these conditions.) I also urge patients with MASLD to lose weight. Even a 10 percent loss in weight can go a long way in managing this condition.
5. MASLD, particularly in its early stages, can be reversible. A FibroScan is a test used to measure liver scarring, or fibrosis. I have seen patients who, after losing weight, eating healthily, exercising, and controlling their diabetes, showed a drop in their fibrosis level on follow-up scans. This is great and empowering: A diagnosis of MASLD does not need to be life-threatening.
6. MASLD can lead to cirrhosis, which can be fatal. Fatty deposits can lead to liver inflammation, which can cause liver scarring, or fibrosis. Fibrosis can lead to cirrhosis, a serious and sometimes fatal liver problem that can lead to liver failure and liver cancer. People with cirrhosis usually do develop symptoms, such as fatigue, jaundice (yellowing of the skin or eyes), weight loss, mental confusion, itchy skin, and pain in the upper right abdomen, near the liver. Some may vomit blood because of bleeding in the digestive tract. Many patients with cirrhosis need to consider liver transplantation.
7. A diagnosis of MASLD can be a wake-up call. Many patients diagnosed with diabetes, high blood pressure, obesity, high triglycerides, or high cholesterol don’t realize that these problems can affect their liver. Once they are diagnosed with MASLD, however, they want to take control of their health and prevent cirrhosis. I applaud patients for taking steps to get their health back on track.
Feature image by sebra/stock.adobe.com
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