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Medically reviewed and verified by Kate Burke, MD, MHA
There can be a lot of confusion or uncertainty around certain health conditions. A huge amount of information is immediately accessible on the internet, but this can sometimes muddy the water. When it comes to a condition like metabolic dysfunction-associated steatohepatitis (MASH), certain myths have become widespread. MASH and metabolic dysfunction-associated liver disease (MASLD) are increasingly common liver conditions that affect millions worldwide. While MASH and MASLD are often tied to obesity and weight gain, the idea that these conditions are exclusively caused by weight is a myth. The reality is that a number of risk factors contribute to the development of these diseases. So, what is the relationship between MASH, weight, and other contributing factors? PatientsLikeMe will give you a clearer understanding.
What Is MASH?
MASH is a severe form of MASLD and is characterized by inflammation and liver cell damage because of fat building up in the liver. Unlike simple fatty liver disease, MASH can lead to fibrosis (scarring), cirrhosis, and potentially liver failure. Both MASLD and MASH are linked to metabolic dysfunction, which affects how the body processes food and stores energy.
Myth: MASH Is Only Caused by Weight Gain
A common misconception is that MASH only happens to people who are overweight or obese. While obesity is a significant risk factor, it is not the only cause! Many people with a healthy weight can still get MASH because of other factors like genetics, insulin resistance, and metabolic syndrome. Focusing only on weight oversimplifies a complex medical condition and can lead to delayed diagnoses in people who are not overweight. Furthermore weight loss, when done too quickly, can sometimes worsen liver conditions like MASH. This underscores the importance of understanding all the factors involved in liver health rather than focusing on weight alone.
Many people with a normal body mass index (BMI) may have underlying metabolic dysfunction or genetic predispositions that put them at risk. Similarly, people who consume little to no alcohol can develop MASH due to metabolic factors. If you are concerned about your liver health, speak with a healthcare provider about screening tests, such as liver function tests or imaging studies. Early diagnosis can help prevent complications and improve long-term outcomes.
Risk Factors
MASH and MASLD are complex conditions and are impacted by a wide range of risk factors.
Obesity
Excess body weight is one of the most well-known risk factors for MASLD and MASH. Up to 90% of people with severe obesity are estimated to have MASLD. However, it is not just about total weight. Where the weight is stored also matters! Fat around the abdomen increases the risk more than fat stored in other areas like the thighs or buttocks.
High Blood Sugar and Insulin Resistance
High blood sugar and insulin resistance are closely tied to the development of MASLD and MASH. These are common in people with type 2 diabetes. Insulin resistance interferes with the body's ability to regulate fat storage, leading to an increased risk of fat buildup in the liver.
High Cholesterol and Triglycerides
People with hyperlipidemia (high cholesterol or triglycerides) have a higher likelihood of getting MASLD. Too much fat in the blood can eventually build up in the liver, which contributes to inflammation and damage.
Metabolic Syndrome
Metabolic syndrome is a cluster of conditions. It includes high blood pressure, high blood sugar, abnormal cholesterol levels, and abdominal obesity. Having metabolic syndrome significantly increases the risk of getting MASLD and MASH.
Genetics
Certain genetic factors can make people more likely to develop MASLD and MASH. For example, people of Hispanic descent are more likely to have these conditions, while non-Hispanic Black individuals are less likely to get them. Researchers continue to look at exactly why this is.
Hormonal Changes
The risk of MASLD and MASH increases with age, particularly after the age of 40. Hormonal changes, such as reduced estrogen levels after menopause, may also play a role in disease progression.
Lifestyle Changes to Manage MASH
Although MASH is influenced by many factors, certain lifestyle changes can help quite a bit in managing the condition! Here are some steps you can take that can help improve liver health.
1. Weight Loss
For people who are overweight, losing even 3% to 5% of body weight can reduce liver fat. To lower inflammation and scarring, weight loss of 7% to 10% is often recommended. Gradual weight loss (1 to 2 pounds per week) is safer and more sustainable than rapid weight loss, which can worsen liver damage.
2. Healthy Diet
A balanced diet low in sugar, saturated fats, and processed foods can support liver health. The Mediterranean diet, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, has shown promise in reducing liver fat and inflammation.
3. Physical Activity
No surprise here. Regular exercise can improve insulin sensitivity and reduce fat in the liver. A combination of aerobic exercise and strength training is particularly effective.
4. Medical Interventions
In some cases, medications or bariatric surgery may be necessary to manage obesity and related metabolic conditions. These can help slow the progression of MASLD and MASH.
MASH and MASLD are complex conditions with many contributing factors. While weight and obesity play a significant role, they are not the only risk factors! By understanding the broader range of risk factors, including genetics, diet, and metabolic health, we can improve awareness and ensure more people receive the care they need.
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