What is Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)?

The New York Times recently published an informative article about MASLD, or metabolic dysfunction-associated steatotic liver disease. The article centers around one woman’s diagnosis (and eventual death) from MASLD. We thought it was important for our readers to know more about this disease, and why it seems to take so much time to diagnose.

From the Times:

Geraldine Frank was looking forward to celebrating her 62nd birthday when her son noticed some yellowing in her eyes. He wasn’t too concerned but wanted her to see a doctor.

It turned out that Ms. Frank’s eyes were showing signs of jaundice. She had cirrhosis, severe scarring of the liver that usually takes years, or even decades, to develop.

Ms. Frank had been overweight and saw doctors for other conditions, her son David Frank said, but she never mentioned hearing any concerns about her liver. “How is it possible, with all the medical advances, that nobody knew this was a problem?” he said.

Ms. Frank died five weeks later, as her condition was so advanced it was no longer treatable.

About MASLD

So, what exactly is metabolic dysfunction-associated steatotic liver disease? Per the Cleveland Clinic:

Steatotic (fatty) liver disease (SLD) occurs when your body begins storing fat in your liver. Some fat in your liver is normal, but when more than 10% of your liver’s weight is fat, it may begin to suffer. Excessive alcohol use is one common reason for SLD. But many people develop it without using alcohol. This is called metabolic dysfunction-associated steatotic liver disease (MASLD).

They also note that MASLD affects up to 25% of people worldwide, and most people won’t have symptoms – or even know that they’re experiencing the condition. Further:

2% to 5% of people will experience complications from the fat in their livers. When fat leads to inflammation and cell damage in your liver, it’s called steatohepatitis. The non-alcohol related version is called metabolic dysfunction-associated steatohepatitis (MASH).

Previously, MASH was known as non-alcohol related steatohepatitis (NASH).

Symptoms and causes of MASLD

With MASLD, people typically don’t experience any symptoms until it progresses to MASH. MASH may present with symptoms of inflammation, like pain and swelling in the lower right abdomen (where the liver is). However, patients may not notice any symptoms until MASH progresses into more severe liver damage. Notes the Cleveland Clinic, “MASLD merely lays the groundwork.”

Researchers still aren’t sure what causes MASLD in non-drinkers, but they believe a variety of factors are at work:

• Metabolic syndrome. MASLD is linked to a group of metabolic disorders, including high body mass index, high blood lipid levels, high blood pressure, and diabetes. These factors can all influence each other and change how your body stores fats and metabolizes nutrients.
• Diet and nutritional causes. A diet high in fructose can increase your risk of developing MASLD. Per the Cleveland Clinic, “fructose is one of the ingredients in common table sugar and is the dominant ingredient in high-fructose corn syrup, a common sweetener.”
• Your genes can make it more likely that you develop MASLD. “This may help explain why some people get it without any of the other common risk factors.”

Complications of MASLD

MASLD can result in severe complications to your health, including:

• About 20% of people with MASLD develop MASH, which is a state of chronic liver inflammation. This can progressively damage your liver, eventually resulting in scar tissue – otherwise known as cirrhosis.
• Pregnancy complications. MASLD in pregnancy is linked with an increased risk of complications, for both the pregnant person and the fetus. Pregnant people are three to four times more likely to develop complications like preeclampsia.

What is the treatment for MASLD?

Unfortunately, there is currently no medication to reverse MASLD. However, making changes to your diet, how much you drink, and increasing your activity can help. The Cleveland Clinic notes that “Many people find that they can slow, stop and even reverse the fat accumulation in their liver by managing metabolic factors such as weight, cholesterol (and other blood lipids), blood pressure and blood sugar. However, once MASH progresses to cirrhosis of your liver, the damage becomes more permanent.”

Am I at risk for MASLD?

Per the New York Times:

Patients with Type 2 diabetes or obesity — particularly those with excess fat around the abdomen — are at greatest risk, liver experts said. In these patients, insulin resistance and excess calorie intake, especially from saturated fats and carbohydrates, can lead to fat buildup in the liver that makes it susceptible to injury. And fat itself releases chemicals that cause inflammation and damage liver cells.

Medical professionals can help identify who might be at risk of advanced liver disease using what’s called an FIB-4 score, calculated using routine lab tests. However, such screening isn’t widespread, and most patients aren’t diagnosed until they begin to experience cirrhosis. Says Dr. Arun Sanyal, director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at the Virginia Commonwealth University School of Medicine, “This person did not wake up with cirrhosis. It takes 20-plus years to develop.”

Medical malpractice and MASLD

With MASLD, medical malpractice often involves a delayed or missed diagnosis. This can worsen your condition by allowing the disease to progress untreated. This progression can lead to severe health complications, requiring invasive treatments and possibly leading to irreversible liver damage.

If you or a loved one has suffered due to a misdiagnosis of MASLD, you may be eligible to seek compensation for your medical costs, lost income, and pain and suffering. Speaking with the medical malpractice attorneys at Paulson & Nace, PLLC, can be invaluable to your situation. We can review your medical records, consult with experts, and establish negligence, working to ensure you receive the legal support and maximum compensation you deserve for your losses.

Please contact Paulson & Nace, PLLC, through this contact form or by calling our office.