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What is MASH?
What Is Metabolic Associated Steatohepatitis (MASH)?
Christina George
Physician Reviewed
Sep 24, 2025
If you’ve recently heard the term “metabolic associated steatohepatitis (MASH)” from your doctor or online, you might be wondering, “what exactly does this mean?". The name is long and may sound complicated but understanding it can help you take control of your health. In this article, we’ll break down what MASH is, how it develops, why it matters, and what you can do if you or a loved one is affected.
Breaking Down the Term
The best way to understand a complex medical word is to look at each piece individually. Metabolic associated means it is linked to metabolism, which is the way your body uses and stores energy from food. It usually refers to conditions like obesity, insulin resistance, type 2 diabetes, and high cholesterol. These diseases are the root of the problem that leads to the progression of liver disease caused by abnormalities in metabolism. Next, it’s time to look at the long word steatohepatitis. It’s easier to understand than it looks: “steato” means fat, “hepat” refers to the liver, and “itis” means inflammation. So, when we put it all together, MASH means liver inflammation caused by fat accumulation in the setting of metabolic problems.
From Fatty Liver to MASH
Many people start out with metabolic associated steatotic liver disease (MASLD), which simply means there’s too much fat in the liver. The liver is not meant to store fat. This early stage is sometimes called “fatty liver disease”. This may be found incidentally on medical imaging like an ultrasound when looking for something else.
Having fat in the liver doesn’t always cause damage right away. But in some people, the fat eventually leads to irritation and inflammation. Over time, this inflammation causes scarring (stiffness) in the liver. That more serious stage is what is known as MASH. Here’s a simple way to picture it: MASLD (fatty liver) is a storage problem (too much fat sitting in the liver) This could possibly lead to MASH, the inflammatory stage (the fat causes inflammation and scarring).
Why Does MASH Happen?
The exact reasons why some people with fatty liver develop MASH while others don’t are still being studied. But research shows that several factors work together. Insulin resistance occurs when your body doesn’t respond well to insulin, causing more sugar to stay in your blood. Your liver often stores this extra energy as fat. This also leads to obesity and extra weight around the belly. Abdominal fat in particular increases inflammation and stress on the liver. Type 2 diabetes results in high blood sugar over time, perpetuating the damaging activity in the liver. High cholesterol and triglycerides mean there’s extra fat in the blood that can end up deposited in the liver. There is also a genetic component to fatty liver disease and MASH. Some people are simply more likely to develop MASH due to inherited traits. There are things that you can control like lifestyle factors. Diets high in processed foods, sugary drinks, and alcohol (even in small amounts for some people) can add to the risk.
Think of your liver as the body’s filter and energy manager. When it’s overloaded with fat and sugar, and inflammation sets in, it starts to develop scarring, like what happens if a cut on your skin doesn’t heal properly.
Why MASH Matters
MASH isn’t just a medical buzzword. It’s a condition that can have real consequences if ignored. Over time, ongoing inflammation and scarring in the liver can lead to fibrosis, which is early scarring of the liver. The nest stage is cirrhosis. This is advanced scarring that makes it hard for the liver to work properly. After some time, cirrhosis can progress to liver failure where the liver is unable to perform its vital functions. MASH also increases the risk of liver cancer, even before cirrhosis.
The liver has an incredible ability to heal and regenerate. But if damage continues unchecked, the scarring becomes permanent. That’s why catching and treating MASH early is so important.
Who Is at Risk?
You may be at higher risk of developing MASH if you have metabolic risk factors, including overweight or obesity, especially around the waist, type 2 diabetes, high cholesterol or triglycerides, high blood pressure, polycystic ovary syndrome (PCOS), obstructive sleep apnea, and even a family history of fatty liver or cirrhosis
It’s worth noting that MASH is not just a condition of people who are overweight. Thin people can also develop it, especially if they have insulin resistance or a strong family history.
Signs and Symptoms
One of the biggest challenges with MASH is that it’s often called a silent disease. Most people don’t notice symptoms until the liver is already badly damaged by scarring. When symptoms do appear, they might include fatigue (feeling very tired), discomfort or pain in the upper right side of the belly, unexplained weight loss and weakness. If MASH progresses to cirrhosis, more serious signs can develop, such as yellowing of the skin (jaundice), swelling in the legs or belly, or confusion. Because symptoms are vague, screening and testing are crucial if you’re in a higher-risk group.
How Is MASH Diagnosed?
Doctors use several tools to figure out if someone has MASH starting with a good medical history, both personal and family, along with a physical exam and blood tests. These tests are checking liver enzymes (AST, ALT) for signs of irritation in addition to looking for related conditions like diabetes and high cholesterol. Imaging modalities such as ultrasound, CT scans, or MRI can reveal fat in the liver. Special scans called FibroScan® or elastography measure liver stiffness, which indicates scarring. This test is not diagnostic, but rather a screening tool to guide next steps in diagnosis. A liver biopsy is done by obtaining a tiny sample of liver tissue and looking at it under a microscope. This is still the gold standard to confirm MASH and measure fibrosis. These approaches are often combined to get the clearest picture.
Treatment and Management
Right now, there are two FDA approved treatments for MASH. One is a pill called Rezdiffra (resmiterom), and the other is an injection called Wegovy (semaglutide). In addition to medications, lifestyle changes and medical care can slow, stop, or even reverse early damage.
Lifestyle Modifications
Weight loss is usually the first recommendation in improving the health of your liver. Even losing 7–10% of body weight can significantly reduce liver fat and inflammation. Focus on a healthy diet. The Mediterranean diet is a beneficial style of eating for MASLD and MASH according to the research. Concentrate on whole foods, including many fruits and vegetables, lean proteins, whole grains, nuts, and healthy fats. Processed carbohydrates should be eliminated as much as possible. Cut sugary drinks out of your diet. This is a relatively easy way to get rid of empty calories. Processed (packaged) snacks are strongly linked to fatty liver. Next, turn your attention to exercise. Aim for at least 150 minutes of moderate activity (like brisk walking) per week, plus muscle-strengthening twice a week. Finally, give your liver the best chance and avoid alcohol. Even small amounts can worsen liver damage in MASH.
Medical care
Management of chronic metabolic conditions is very important. Diabetes, cholesterol and high blood pressure should be optimally controlled to protect the liver and prevent damage. There is some evidence that supplements like vitamin E may help improve fatty liver disease. Clinical trials are ongoing to bring new medications to the market to treat MASH. Participating in a clinical trial may give access to promising treatments.
Prevention: Protecting Your Liver
Even if you don’t have MASH, you can take steps to keep your liver healthy. Implementing the lifestyle modifications above can go a long way in preventing MASH. It is important to maintain a healthy weight by first optimizing your nutrition: choose water or unsweetened drinks instead of sodas and juices, eat plenty of vegetables, fruits, and fiber. Stay active by walking, biking, swimming, or dancing; any activity that gets you moving counts! Get regular checkups and blood work, especially if you have diabetes or high cholesterol. Limit alcohol as much as possible. Think of these steps as not only protecting your liver, but also improving your overall heart and metabolic health.
Living with MASH: Hope and Support
A diagnosis of MASH can feel overwhelming, but it’s important to know that you’re not alone. Millions of people worldwide are affected, and awareness is growing. The liver can heal. With the right changes, the liver often improves. Support is available; working with a healthcare team consisting of doctors, nurse practitioners, dietitians, and sometimes psychologists can make a big difference.
Many patients find it helpful to join support groups or connect with others facing the same diagnosis. Managing MASH is a long-term journey, but one where small, steady steps lead to big results.
Metabolic associated steatohepatitis is a serious but manageable condition. The name may be new and complicated, but the message is simple: with awareness, early diagnosis, and healthy lifestyle changes, many people with MASH can protect their liver and live full, active lives.
If you think you might be at risk or have questions about your liver health, talk with your healthcare provider or reach out to Covenant Metabolic Specialists. We’re here to guide you every step of the way.
