Blog
What is Metabolic Associated Steatotic Liver Disease (MASLD)
A Deep Dive into the Liver's Newest Medical Epidemic
Nicholas Kruzdlo
Physician Reviewed
Sep 24, 2025
Metabolic associated steatotic liver disease or (MASLD) for short, is a chronic liver disease characterized by excess fat being stored in the liver due to metabolic insufficiencies. MASLD has not always been called what it is today. Previously referred to as non-alcoholic fatty liver disease (NAFLD) or even more broadly as Fatty Liver Disease, the diseases name was updated to MASLD in 2023. Why might you ask? The MASLD nomenclature highlights the root cause of the disease state, which is metabolic dysfunction. While also dissociating the world alcohol from the name, as alcohol does not play a role in the formation or progression of MASLD. It is a common misconception that alcohol is always the cause of liver disease. MASLD shows us that this is not the case. Other factors like insulin resistance and fat storage can cause chronic damage to the liver over time.
MASLD is the first step in the progression of “liver disease” caused by metabolic dysfunction in the body. With increasing prevalence worldwide, it’s becoming a bigger societal public health concern every day. In this article we will break down what MASLD is, while highlighting its causes, symptoms, risk factors, diagnosis, treatment options, and prevention strategies. All to bring awareness, education and a set of actionable steps to treat this rapidly growing disease state.
What is MASLD?
MASLD, or metabolic-associated steatotic liver disease, is a condition characterized by the accumulation of fat, greater than 5%, in the liver. This fat accumulation is caused by a set of metabolic risk factors that we will explore later on. MASLD is completely separated from alcohol-related liver disease, and other forms of liver disease caused by viral infections, drugs, and autoimmune issues. MASLD can and will develop in individuals who drink little to no alcohol. This is because the fat accumulation in the liver is triggered by a different factor, which is metabolic dysfunction.
What is Metabolic dysfunction?
Metabolic dysfunction is defined as insulin resistance, abnormal fat metabolism, high blood pressure, and excess body fat. Things that are all increasingly common in today’s world. It is the increase in these metabolic issues worldwide that is causing such an increase in the prevalence of this disease state.
Untreated MASLD won’t remain as benign fat accumulation in the liver forever. Over time, as fat continues to build in the liver, the cells that make up the liver struggle to do their job more a more. These liver cells or hepatocytes become so unhealthy they begin to die off. Once these healthy liver cells die, they are replaced with scar tissue causing the progression to more severe liver condition called metabolic associated steatohepatitis (MASH). In short MASH is a progression of MASLD where excess fat turns into excess fat and the presence of scar tissue.
How Common is MASLD?
MASLD is far more common than you think. It’s estimated that one in four people worldwide and close to 50% of adults have some form of MASLD, making it one of the most common chronic liver diseases. Its increasing prevalence is directly correlated to the growing rates of obesity, type 2 diabetes, and metabolic syndrome. In fact, it is estimated that in the next decade the leading cause of liver transplants will no longer be due to alcohol. Instead, it will be due to cirrhosis caused by the MASLD to MASH to Cirrhosis progression.
Even with the currently striking numbers on MASLD’s prevalence, medical professionals are continuing to realize the extent of this disease state is greater than we imagined, making MASLD.
MASLD is almost always a silent disease. This means many people are walking around undiagnosed and unaware this is currently affecting them. Testing for MASLD is a growing effort within the medical community, however, nowadays diagnosis usually happens incidentally during imaging for other health conditions.
Causes and Risk Factors: How do I know if I am at risk for MASLD?
The development of MASLD is directly linked to its route cause of metabolic dysfunction. The condition with the highest correlation to the development of MASLD is Type 2 diabetes. This is because Type 2 diabetes and MASLD form due to the same metabolic pathways, and when these pathways become insufficient these diseases often for side by side. Other important risk factors include…
High blood pressure
High LDL cholesterol levels
High triglyceride levels
Hypothyroidism
PCOS
Obstructive Sleep Apnea (OSA)
The more risk factors someone has and the worse those risk factors are, the higher likelihood they have MASLD.
Outside of medical conditions, genetics can also increase susceptibility in some individuals. We currently know that Hispanic and Asian population are more susceptible to MASLD due to genetic predisposition and how their body stores fat.
Beyond biology, lifestyle plays a big role too—sedentary behavior combined with diets high in refined sugars, saturated fats, Omega-6s, inflammatory compounds, and processed foods worsens the condition. This overall high calorie intake and low energy expenditure worsen the genetic and medical factors that play into MASLD. All of these risk factors work together to store fat in the liver and they need to be addressed holistically to try and address the route cause.
Symptoms and Warning Signs: What do I need to look for?
The largest challenge in the fight against MASLD is that it’s often a silent disease. In the early stage of MASLD, most people experience no symptoms. MASLD is completely undetectable based on patient physical appearance and patient reported symptoms. Patients and clinical personal must relay on the identification of risk factors, lab work, and liver imaging to identify if a patient is suffering from MASLD. It is not until the disease progresses to MASH or even cirrhosis that some individuals may notice fatigue, unexplained weight loss, discomfort or pain in the upper right abdomen, or a general sense of weakness, jaundice, swelling in the legs or abdomen, and even confusion. By this point, the liver is severely compromised, and possible treatments will become less effective, make the importance of early detection far greater.
How MASLD is Diagnosed
Because it is so often silent, MASLD is frequently discovered incidentally on abdominal imaging such as an MRI or Ultrasound. Specific diagnostic approaches will include a combination of testing. Blood tests can look for elevated liver enzymes such as ALT and AST. If elevated the values can raise suspicion though they will not provide definitive answers.
Imaging tests like ultrasound, MRI, or CT scans can reveal the presence of fat in the liver. A more specific liver imaging device called a FibroScan (also known as transient elastography) measures liver fat content numerically. FibroScans can quantify fat content numerically between the numbers 100 dB/m – 400 dB/m. Where anything over 250 dB/m may suggest MASLD.
In more advanced cases where a physician thinks a patient’s MASLD has progressed to MASH or cirrhosis where scaring is present, a liver biopsy remains the gold standard for identifying this fibrosis. With today’s improvements in medical technology biopsies are usually not needed in the diagnosis of MASLD due to other imaging techniques.
Treatment Options for MASLD: Are there any available?
Currently, there is no specific FDA-approved medication for MASLD, though research is ongoing. Management typically focuses on addressing the underlying metabolic dysfunction and reducing liver fat. Lifestyle changes are the cornerstone of treatment, with weight loss achieved through diet and exercise proving very effective. A reduction in body weight of just 5 percent can significantly decrease liver fat content. Dietary modifications emphasize whole foods, lean proteins, vegetables, fruits, and reduced intake of added sugar. Many experts recommend the Mediterranean diet. Exercise, both aerobic and resistance training, further improves insulin sensitivity and reduces liver fat.
In terms of medication, while nothing is FDA approved for MASLD we can still address patient risk factors with medications. Drugs used to treat diabetes, such as GLP-1 receptor agonists, FDA approved for T2D and weight loss have demonstrated that their downstream effects positively affect the MASLD disease state through weight loss and better glucose control. Finally, treating associated conditions like high blood pressure, diabetes, and abnormal cholesterol helps slow disease progression and protect overall health.
Prevention and Outlook
The good news is that MASLD is largely preventable. Maintaining a healthy weight, engaging in regular physical activity, and eating a balanced diet rich in nutrients are powerful tools in lowering risk. Avoiding processed foods and sugary drinks while prioritizing fresh, whole foods supports both metabolic and liver health. Regular monitoring and management of blood sugar, cholesterol, and blood pressure also play key roles.
For those already diagnosed, early lifestyle interventions can reverse fat accumulation and even early fibrosis. Lifestyle modification like a better diet and increase in exercise paired with medications to control risk factors can reverse a MASLD diagnosis. Without action, however, MASLD can progress to advanced and life-threatening liver disease over a lifetime.
MASLD is a growing global health concern linked to metabolic dysfunction. Though often silent, it can progress to severe liver disease if left unaddressed. Understanding its causes, risk factors, and treatment strategies is key to both prevention and management. The shift from the term NAFLD to MASLD underscores the central role of metabolic health, reminding us that improving diet, increasing physical activity, and managing chronic conditions can dramatically improve liver outcomes.
In short: MASLD is preventable, manageable, and, in some cases, reversible—but only if recognized early and taken seriously. By spreading awareness and encouraging proactive health habits, we can help curb the rising tide of this disease.
