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MASH Symptoms
Recognizing the Symptoms of Metabolic Associated Steatohepatitis
Julissa Taveras
Physician Reviewed
Sep 25, 2025
Metabolic Associated Steatohepatitis, commonly known as MASH, is a liver condition that is becoming more widely recognized in recent years. If you have ever heard of “fatty liver disease,” MASH is a more serious form of it. Many people live with this condition without realizing it, because symptoms often develop slowly or can be mistaken for other health issues. This article is here to help you understand what MASH is, what symptoms to look out for, and why paying attention to your liver health is so important. Before we get started, it is important to note that MASH was previously known as NASH (non-alcoholic steatohepatitis), the name of the condition was changed as MASH is more closely related to a metabolic condition no primarily alcohol or the lack thereof.
What Is MASH?
To start, let’s break down what the name means:
Metabolic Associated – This means the condition is linked to metabolism, or how your body processes food and energy. People with conditions such as obesity, type 2 diabetes, high cholesterol, or high blood pressure are at higher risk.
Steato- – This comes from the Greek word for fat. It means there is fat buildup in the liver.
Hepatitis – This refers to inflammation in the liver.
So, MASH is essentially fatty liver disease with inflammation and liver cell damage, which can cause scarring (fibrosis) if left untreated. Over time, MASH can progress to cirrhosis, liver failure, or even liver cancer.
Why MASH Often Goes Undetected
One of the biggest challenges with MASH is that it’s often called a “silent” disease. In the early stages, most people don’t feel sick. The liver can quietly accumulate fat and develop inflammation without obvious warning signs. That’s why doctors sometimes discover it only when blood tests show abnormal liver enzymes or when imaging is done for another reason.
However, as the condition progresses, certain symptoms may appear. Knowing what to look for can help you and your healthcare provider catch it early and take steps to protect your liver.
Common Symptoms of MASH
Fatigue and Low Energy
One of the most common complaints among people with MASH is feeling tired all the time. This isn’t just ordinary tiredness after a long day—it’s persistent fatigue that doesn’t improve with rest. Liver inflammation can affect how your body processes nutrients, leaving you drained of energy.
Discomfort or Pain in the Upper Right Abdomen
The liver sits in the upper right side of the abdomen, just below the rib cage. As it becomes enlarged or inflamed, some people notice:
A dull ache or heaviness in that area
Intermittent sharp pains
Discomfort that worsens after eating fatty foods
While not everyone with MASH feels this, abdominal pain in that spot should not be ignored.
Unexplained Weight Changes
Weight gain, especially around the midsection, is strongly linked with MASH. On the other hand, some people may notice unexplained weight loss in late stages as liver function worsens. The body’s ability to process fats, sugars, and proteins changes when the liver is inflamed, which can show up as unexpected changes on the scale.
Digestive Issues
Because the liver plays a key role in digestion, people with MASH may experience:
Nausea
Loss of appetite
Indigestion or bloating
Constipation or diarrhea
These symptoms are easy to dismiss as minor stomach troubles but may be linked to liver function.
In Later stages we can see the following signs and symptoms
Swelling (Edema) and Fluid Retention
As the disease progresses, some people develop:
Swelling in the legs and ankles
A bloated belly (ascites) from fluid buildup
Puffiness in the face or hands
This usually signals more advanced liver damage, when the organ is struggling to regulate fluid balance.
Changes in Mental Clarity
In advanced stages, toxins that the liver normally filters can build up in the bloodstream and affect the brain. This is called hepatic encephalopathy and may appear as:
Brain fog
Difficulty concentrating
Memory problems
Mood swings or irritability
This doesn’t usually occur in early MASH, but it is important to recognize in later stages.
Skin and Eye Changes
The skin and eyes can sometimes provide early hints of liver problems. Watch for:
Yellowing of the skin or eyes (jaundice)
Itchy skin
Easy bruising
Dark urine or pale stools
These signs often appear when liver damage has become more advanced.
Who Is Most at Risk for MASH?
Anyone can develop MASH, but certain health conditions make it more likely:
Obesity or being overweight
Type 2 diabetes
High blood pressure
High cholesterol or triglycerides
Sedentary lifestyle
Sleep apnea
Genetic predisposition
It’s also worth noting that some people develop MASH even if they are not overweight, particularly if they have metabolic issues or a family history of liver disease.
How Can We Check for MASH?
If you have symptoms or risk factors, we may suggest:
Blood tests to check liver enzymes
Imaging tests like Fibroscan, ultrasound, or MRI to look for fat and scarring
Liver biopsy in select cases, to confirm the diagnosis and stage of disease
Early detection is key, since lifestyle changes and treatment can help slow or even reverse the disease in many cases.
What You Can Do If You Have Symptoms
If you suspect you may have MASH, the most important step is to talk to your healthcare provider. Do not ignore persistent fatigue, abdominal discomfort, or unexplained weight changes.
Some practical steps you can take to support your liver health include:
Eating a balanced diet rich in vegetables, lean protein, and whole grains
Limiting added sugars, refined carbs, and alcohol
Staying active with at least 150 minutes of moderate exercise per week
Managing weight, blood sugar, and cholesterol through lifestyle and medication if needed
Targeted approach to improve your liver function and overall live health.
Living with MASH: Hope and Outlook
While hearing you may have MASH can be overwhelming, it’s important to know that the condition is manageable, especially when caught early. Many people are able to improve their liver health significantly with targeted treatments and through lifestyle changes. Ongoing research is also exploring new medications that may become available in the near future. For people living with MASH now, receiving treatment through a clinical trial is a great option for improvement of the condition at no cost.
Remember: your liver is a resilient organ. With proper care, it has the ability to heal. The key is awareness, early detection, and targeted treatment that we, at Covenant Metabolic Specialists might be able to help with.
MASH is a growing health concern worldwide, but you don’t have to face it alone. By understanding the symptoms—such as fatigue, abdominal discomfort, unexplained weight changes, swelling, digestive issues, and skin or eye changes, and your risk factors such as obesity, diabetes, cholesterol, high blood pressure, PCOS, sleep apnea, among others—you can take charge of your health and get the support you need.
If you recognize any of these symptoms in yourself or a loved one, reach out to us, take our metabolic risk quiz and we might be able to help. Early action can make all the difference in protecting your liver and your overall well-being.
