Liver health is intricately related to overall metabolic health.¹ Studies show that incidences of certain chronic liver diseases have increased, in parallel to increases in obesity and metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a type of chronic liver disease characterized by metabolic abnormalities that gives an insight into how metabolic health affects overall health, including liver health.

 

What is MASLD?

MASLD is a chronic liver disease that was previously known as nonalcoholic fatty liver disease.¹ It is a condition marked by accumulation of fat in the liver that is not caused by excessive alcohol consumption.

 

How Is MASLD Diagnosed?

MASLD is diagnosed when hepatic steatosis (ie, accumulation of fat in liver) is detected by imaging, blood biomarkers, or liver history, and when the following conditions are met:¹

• Overweight or obese
• Type 2 diabetes mellitus, or
• Presence of two or more metabolic risk abnormalities such as
• Blood pressure >130/85 mm Hg or on specific drug treatment
• Waist circumference >102/88 cm in Caucasian men/women or >90/80 cm in Asian men/women
• Triglycerides >150 mg/dL or specific drug treatment
• High-density lipoprotein cholesterol <40 mg/dL in men and <50 mg/dL in women or specific drug treatment
• Prediabetes or 2-hour post-load glucose level 140-199 mg/dL
• Homeostatic model assessment for insulin resistance >2
• High-sensitivity C-reactive protein level >2 mg/L

 

How Is Liver Health Related to Metabolic Health?

Studies have shown that metabolic health affects liver health, with metabolic abnormalities increasing the risk of MASLD significantly.² For instance, features of the metabolic syndrome increase the risk of developing MASLD and are also highly prevalent in individuals with MASLD. Obesity, type 2 diabetes mellitus, hypertension (ie, high blood pressure), and dyslipidemia (ie, imbalance of blood lipids) are established conditions for MASLD. Despite ongoing research, the exact mechanism of how metabolic abnormality may cause liver damage is still unknown. Researchers hypothesize that accumulation of visceral adipose (ie, fat) tissue may produce inflammatory markers that induce systemic insulin resistance. It is thought that this insulin resistance may cause abnormalities in lipid metabolism that lead to the accumulation of fat in the liver.

 

How Is MASLD Treated and Managed? 

Lifestyle intervention is key to improving liver health.¹ Various studies have shown that lifestyle modification involving caloric restriction, increased physical activity, and weight loss led to significant improvements in MASLD. Some studies have found that lifestyle intervention can lead to the resolution of 90% of metabolic dysfunction-associated steatohepatitis and 97% of steatotic liver disease. Current guidelines suggest gradual weight loss (<1 kg/week) through low-calorie diet (500-1,000 kcal deficit) and physical activity (30 minutes/day of moderate intensity exercise for >5 days/week) to manage MASLD.