What is MASLD?
Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is the medical term for fatty liver where excess fat accumulates in the liver and is linked to metabolic health problems such as being overweight, having diabetes, high blood pressure, or high cholesterol.
Risk factors
- Smoking
- Alcohol
- Diabetes
- High blood pressure
- High cholesterol
- Obesity (BMI>23 kg/m2)
- Increased belly fat (waistline ≥90cm for males or ≥80cm in females)
Symptoms
MASLD usually does not cause symptoms. If symptoms are present, they may be non-specific type symptoms of tiredness and discomfort over the right upper abdomen. However, if MASLD progresses to cirrhosis (hardening of liver), signs and symptoms of cirrhosis may appear, including:
- Yellow skin & eyes (jaundice)
- Confusion or difficulty concentrating (hepatic encephalopathy)
- Easy bruising or bleeding
- Ascites (abdominal swelling from fluid accumulation)
How is MASLD diagnosed?
MASLD is diagnosed by a combination of history, physical examination, blood tests and imaging studies of the liver.
- Liver function tests such as liver enzymes (ALT, AST) may be elevated
- Ultrasound, CT or MRI scans may show fatty liver
- Fibroscan or MR Elastography
Complications
MASLD exist as a spectrum. At the milder end there is simple steatosis (fatty liver). If not well managed, it can progress to Metabolic Dysfunction-Associated Steatohepatitis (MASH), which involves inflammation and liver cell damage. Over time, this can lead to fibrosis (scar tissue in the liver), cirrhosis (hardening of the liver) and in some cases liver failure or liver cancer. Cirrhosis, in turn, can disrupt blood flow through the liver and make it harder for the liver to clear toxins from the blood. It can also increase the risk of liver cancer and lead to liver failure.
Treatment
Treatment includes lifestyle modifications such as weight loss, diet, exercise and control of metabolic conditions. There is currently no medication approved in Singapore solely for the treatment of MASLD or MASH.
Prevention
In early stages, MASLD can be reversed through lifestyle changes and prevent its progression to more severe liver conditions.
- Maintain a healthy weight through a balanced diet e.g. healthy plate concept or Mediterranean diet
- Limit intake of processed meat, ultra-processed foods and sugar-sweetened beverages
- Manage conditions such as diabetes, high cholesterol and high blood pressure
- Engage in regular physical activity
4. Reduce alcohol consumption or avoid it entirely
5. Stop smoking
6. Have regular health check-ups to monitor liver function and overall metabolic health
