When we think of liver disease, alcohol is often the first thing that comes to mind. Many people are unaware there’s a silent liver health epidemic affecting millions that is not associated with alcohol, and it’s called metabolic dysfunction-associated steatohepatitis, or MASH. MASH is a progressive form of fatty liver disease that causes liver inflammation, quietly damaging the liver over time, often without presenting any noticeable symptoms. MASH is linked to common conditions like type 2 diabetes, obesity, and high blood pressure, making it an increasingly common disease. As the rates of this condition increase, especially among younger adults, it’s important to understand the risk and warning signs of developing MASH.
MASH Explained: The Silent Liver Threat You Can’t Ignore
Metabolic dysfunction-associated steatohepatitis, previously known as nonalcoholic steatohepatitis (NASH), is often overlooked. It is an advanced stage of metabolic dysfunction-associated steatotic liver disease (MASLD). MASH occurs when excess fat accumulates in the liver, leading to inflammation and liver cell damage. MASH should not be ignored, as, over time, it can progress to serious liver health issues such as liver fibrosis, cirrhosis, liver failure, or even liver cancer. Unfortunately, because it often develops silently, many people don’t know they have it until significant damage has already occurred.
How Fatty Liver Progresses to MASH
Fatty liver, or hepatic steatosis, occurs when your body begins storing excess fat in the liver. While a fatty liver may not cause immediate harm, and may not cause harm for everyone, it can progress into MASH, causing inflammation of the liver. Chronic inflammation can cause damage to the liver, resulting in scarring of the tissues.
Key risk factors for fatty liver progressing into MASH include:
- Obesity
- Type 2 diabetes
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
- Insulin resistance
These risk factors increase liver stress, triggering an inflammatory response that can lead to liver scarring (fibrosis) and worsening liver function. Liver fibrosis can eventually lead to cirrhosis, a condition where normal liver tissue is replaced with scar tissue, which can impair liver function permanently. MASH is one of the leading causes of cirrhosis and is one of the leading causes of liver transplant in the U.S.
Early Warning Signs Your Liver Is Struggling
One of the challenges of diagnosing MASH early is the muted nature of its symptoms. Many people experience no symptoms at all in the early stages. However, there are some signs to look out for that may suggest liver trouble, including:
- Persistent fatigue
- Unexplained weight loss
- Discomfort or pain in the upper right abdomen
- Swelling in the abdomen or legs
- Jaundice (yellowing of the skin or eyes)
- Brain fog or trouble concentrating
If you are experiencing these symptoms, especially if you have any of the previously mentioned risk factors, it’s important to consult your healthcare provider.
The Blood Tests That Reveal Liver Damage
Regular check-ups and monitoring are essential for individuals with risk factors. Since MASH can be silent in its early stages, blood tests are crucial for identifying liver abnormalities. Common tests include:
● Fibrosis-4 (FIB-4) Index: Often the first test recommended for those who are at risk for MASH, FIB-4 is used to assess the likelihood that one has advanced liver scarring.
● Liver function tests: Checks for evidence of inflammation in the liver, such as elevated liver enzymes.
● Lipid panel: Measures levels of fat in your blood, including three measurements of cholesterol levels and a measurement of triglycerides. High levels of these may be a sign of MASH.
Lifestyle Triggers: Alcohol, Sugar, and Sedentary Habits
While MASH is not caused by alcohol consumption (unlike alcoholic liver disease), lifestyle choices still play a significant role in its development. Diets high in sugar, refined carbohydrates, and saturated fats contribute to fat accumulation in the liver. Sedentary behavior and lack of physical activity can further increase the risk of metabolic dysfunction.
Quitting alcohol, even if you’re a moderate drinker, can benefit your liver. Reducing sugar, processed foods, and trans fats is also beneficial. Prioritizing regular physical activity, such as brisk walking or strength training, supports both weight loss and liver health.
Why MASH Is Rising in Young Adults
While MASH has traditionally been associated with older adults, it is increasingly being diagnosed in younger populations, including teenagers and young adults. The increase of childhood obesity, sedentary lifestyles, and poor dietary habits are contributing risk factors to the rise in MASH in younger groups. Early detection and intervention are essential for teenagers and young adults at risk of MASH to prevent long-term liver damage.
Global Fatty Liver Day – June 13th
Educational initiatives, routine screenings, and public health messaging are needed to combat the growing rate of liver disease among younger populations. Global Fatty Liver Day, observed on June 13th, is an opportunity to raise awareness about MASLD and MASH. The goal is to educate the public, support those affected, and promote liver health.
Formerly known as International NASH Day, Global Fatty Liver Day began in 2018. Organizations and healthcare providers, such as the Global Liver Institute, often use this day to launch educational campaigns, host free screening events, and highlight the importance of regular check-ups for at-risk individuals.
When Medication or Further Testing Is Needed
While lifestyle changes are the first treatment used for MASH, some individuals may require medications, especially if they have advanced fibrosis or other complications. The medication resmetirom was approved in 2024 to treat MASH. It is used in combination with lifestyle changes focusing on weight loss. And works by activating a thyroid hormone receptor that reduces liver fat accumulation. Individuals who do not respond to lifestyle changes may need medication to control high blood sugar or high cholesterol, or may benefit from medicine to help with weight loss.
Your doctor may recommend additional tests or referrals to a hepatologist if your condition doesn’t improve or if your liver function worsens despite lifestyle efforts.
When to Talk to Your Doctor
If you have risk factors such as obesity, diabetes, high blood pressure, or a family history of liver disease, talk to your healthcare provider about getting screened for MASH. Early detection can make a significant difference in treatment and outcomes. Don’t ignore persistent fatigue, abdominal discomfort, or unexplained weight changes– these could be early signs of liver trouble.
This article was written for WHN by Shore Gastroenterology Associates, who are dedicated to providing high-quality, compassionate, and comprehensive care, with a priority focus on patient experience to help guide and answer any questions you may have for all your gastrointestinal health needs, about our services, facilities, and more.
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