Estimated reading time: 6 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
Groups like the World Health Organization and independent researchers alike have looked at the global incidence rate of a number of diseases over the past few decades. Cardiovascular diseases, cancers, neonatal disorders and musculoskeletal disorders are the most common. They affected over 1.2 billion people in 2021. But did you know there is a single condition estimated to affect over 30% of all adults worldwide? Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most widespread global chronic liver disease, and in the United States alone cost over $100 billion to treat. If untreated, MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH). MASH can lead to liver scarring, cirrhosis, liver failure, and even liver cancer. Despite being a major contributor to liver transplants, MASH remains widely under-diagnosed. The main reason? Many people do not see symptoms until the disease has already caused significant damage. Here is what you need to know.
MASH: The Silent Disease
One of the biggest dangers of MASH is that it is often called a “silent disease.” Many people with MASH have no noticeable symptoms, especially in the early stages. When symptoms do start to show up, they can be vague and easily confused as the results of other conditions. Common symptoms of MASH are:
- Fatigue
- Abdominal pain, usually in the upper right side
- Issues with cognition
- Anxiety or depressions
- Poor sleep
Since these symptoms are often subtle, most people do not get medical attention until their liver disease has progressed. By then, the damage may be harder to reverse. This is why testing for MASH is so important, even if you feel fine.
MASH is Getting More Common
All the data suggests that MASH is increasing at an alarming rate. This rise is largely because of increasing cases of obesity, type 2 diabetes, and metabolic disorders. In the United States, it is estimated that up to 30% of adults have MASLD, and around 20% of those people have progressed to MASH. That means millions of people may be living with liver inflammation and damage without knowing it. There are certain risk factors that increase the changes you will get MASH:
- Obesity
- Type 2 diabetes
- High cholesterol or high blood pressure
- Insulin resistance
- Family history of cirrhosis
If you have any of these risk factors you should talk to your doctor about testing for MASH. The American Association for the Study of Liver Diseases recommends that people at risk for MASH be reassessed every 1 to 3 years, depending on their individual health profile. The rates of obesity and metabolic disorders are rising worldwide. As a result, the number of people affected by MASH is expected to increase. Without proper screening and early detection, more people could see severe liver damage in the future.
Why Early Testing Matters
The only way to know for sure if you have MASH is through testing. MASH is diagnosed through a combination of clinical evaluation, non-invasive tests, and when necessary, a liver biopsy. Because symptoms are rare in the early stages, routine screening is key for people who are at-risk. Finding it early lets you make changes that can slow and potentially stop the progression of liver disease.
How is MASH Diagnosed?
Doctors use a few different tests to diagnose MASH and find out how advanced it is. They will start with blood tests to check for liver enzyme levels. These can show liver inflammation or damage. Imaging tests, like Ultrasounds, MRIs or FibroScan tests can help find fat build up and liver damage. A liver biopsy, which is when they take a small sample of the liver, can confirm the diagnosis. With advancements in medical technology, noninvasive tests are making it easier than ever to screen for MASH without painful procedures.
The Long-Term Risks of Untreated MASH
Without proper management, MASH can progress to more severe liver conditions. Fibrosis is early scarring of the liver. It does not cause symptoms by itself, and if found early can possibly be reversed depending on the severity of the disease. The liver actually heals itself through a process called apoptosis, which is when damaged cells die off and are replaced by healthy ones. If MASH is not treated however, it can lead to liver cirrhosis. This is when the liver has extensive scar tissue and can no longer function properly. The liver is responsible for filtering toxins out of your blood. If it is damaged, these toxins can build up in your body and will eventually lead to death if untreated. Cirrhosis is also referred to as end-stage liver disease, because it requires a transplant.
MASH increases the risk of liver cancer even in patients without cirrhosis. However, the highest risk is in patients with cirrhosis. A 2021 study found that MASH-related liver cancer cases and deaths have increased significantly over the past two decades. This means that without proper intervention, the number of people developing serious liver disease will continue to rise.
How to Protect Your Liver
If you are diagnosed with MASH or at a high risk for getting it, there are steps you can take to protect your liver! The first is to keep yourself at a healthy weight. Losing 7-10% of your body weight can significantly improve liver health. Focus on your diet. Reduce how many processed foods, sugar, and unhealthy fats you eat while adding more vegetables, lean proteins, and whole grains.
Physical activity helps reduce liver fat and improve overall health. Managing diabetes, high blood pressure, and cholesterol can lower the risk of MASH progressing. Limit your alcohol as well! Excessive drinking can worsen liver damage and increase the risk of cirrhosis.
MASH is a growing global health problem that affects millions of people. Many people have no idea they have the disease! Because MASH often has no symptoms until it has already caused serious damage, early testing is the key to preventing life-threatening liver conditions. If you are at risk, do not wait until you feel sick to take action. Talk to your healthcare provider about screening options and take steps to protect your liver today.
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