Estimated reading time: 5 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
What do you know about the liver? One of our vital organs, the liver plays a key role in keeping the body healthy. It processes nutrients, stores energy, and removes toxins from the blood. Most people think about the liver as it relates to drinking, and that alcohol consumption can harm the liver over time. Were you aware that eating too much food can also cause damage? When overnutrition becomes a daily pattern, the liver can suffer significant harm. Metabolic dysfunction-associated steatohepatitis (MASH) is a condition that can develop because of overnutrition. Over time, if left untreated, MASH can lead to cirrhosis, or severe liver scarring, which is a life-threatening condition. Here is what you should know about cirrhosis, the signs to watch for, and how to avoid it.
What is MASH?
MASH is a severe form of metabolic dysfunction-associated fatty liver disease (MAFLD). It is caused by fat buildup in the liver not related to alcohol use. In MASH, this fat buildup happens alongside inflammation and damage to liver cells. This condition is commonly linked to metabolic syndrome, which includes risk factors like high blood pressure, abnormal cholesterol levels, obesity, and type 2 diabetes.
According to experts, our modern diets and lifestyles have significantly increased the prevalence of MASH. Dr. Wajahat Mehal, director of the Yale Fatty Liver Disease Program, explains that our ancestors’ diets varied between periods of overnutrition and undernutrition. However, today we see mostly consistent overnutrition which overwhelms the liver. This leads to fat storage and inflammation. Over time, this inflammation triggers the formation of scar tissue in the liver, setting the stage for cirrhosis.
What is Liver Scarring (Cirrhosis)?
Cirrhosis is the result of long-term liver damage where healthy liver tissue is replaced with scar tissue. This scarring, known as fibrosis, happens when the liver tries to repair itself from repeated injury or inflammation. The liver is fairly resilient and can repair itself to some extent, but continuous damage can lead to the buildup of scar tissue. This will eventually impair the liver’s ability to function.
In the early stages of fibrosis, the liver can still function normally. However, as scarring progresses to advanced stages, the liver’s ability to process nutrients, filter toxins, and produce important proteins is significantly reduced. Cirrhosis is sometimes referred to as “end-stage liver disease” because it represents the final phase of chronic liver damage.
Why is Cirrhosis Dangerous?
Simply put, you need your liver to survive. Cirrhosis can cause severe complications, many of which can be life-threatening.
- Portal Hypertension: Here, scar tissue restricts blood flow through the liver, increasing pressure in the portal vein. This can lead to swelling in the legs (edema) and abdomen (ascites).
- Varices and Bleeding: Increased pressure causes veins in the esophagus or stomach to enlarge, which is known as varices. Eventually they may rupture and lead to life-threatening bleeding.
- Liver Failure: The more scarring, the less able the liver is to perform vital functions. Eventually this can lead to complete liver failure. Liver failure requires immediate medical intervention, often in the form of a liver transplant.
- Toxin Buildup: A healthy liver removes toxins from your blood. A damaged liver will struggle to do this, leading to a condition called hepatic encephalopathy. This can cause confusion, difficulty concentrating, and even coma.
- Increased Cancer Risk: People with cirrhosis have a significantly higher risk of developing liver cancer.
- Infections and Malnutrition: Cirrhosis weakens the immune system, making it harder for the body to fight infections. It also impairs nutrient absorption, leading to malnutrition.
How MASH Leads to Cirrhosis
MASH develops slowly as excess fat and inflammation damage the liver over time. This chronic damage triggers the body’s repair processes, forming scar tissue. When these cycles of injury and repair continue, the scar tissue builds up in the liver and eventually results in cirrhosis. The danger lies in MASH's "silent progression." Most people with MASH do not have symptoms until the damage has reached an advanced stage. Blood tests or imaging studies, like ultrasounds, are often the first indicators of liver problems. Early detection and intervention are important to prevent irreversible damage.
Why Early Intervention is Crucial
Early detection of MASH and fibrosis is key. If you catch it in its early stages, you can prevent the progression to cirrhosis. Lifestyle changes, like maintaining a healthy weight, eating a balanced diet, and exercising regularly, are also important. Managing conditions like high blood pressure, type 2 diabetes, and high cholesterol can also reduce the risk of liver damage. If you are diagnosed with MASH, a hepatologist (liver specialist) can give you advice on treatments to slow or halt liver damage.
Cirrhosis caused by MASH is a serious health concern that can lead to life-threatening complications. However, it is largely preventable with early detection and lifestyle changes. Understanding the risks and addressing metabolic syndrome can help protect the liver and overall health! If you have risk factors for MASH, like obesity or type 2 diabetes, make sure you get regular check-ups and be proactive with your care.
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