Several comorbidities are associated with nonalcoholic fatty liver disease (NAFLD), including cardiovascular disease, type 2 diabetes, and sleep apnea.

Nonalcoholic fatty liver disease (NAFLD) is now known as metabolic dysfunction-associated steatotic liver disease (MASLD). This new name is more accurate and helps reduce the stigma associated with its older name.

A group of multinational liver societies and organizations, including the American Association for the Study of Liver Diseases (AASLD), developed and finalized the name change and announced it in June 2023.

MASLD develops when extra fat builds up in the liver. It’s diagnosed when fat makes up more than 5% of the liver’s weight but without inflammation or damage in the liver.

MASLD may progress to another condition called metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH). MASH is when the extra fat in the liver starts to cause damage.

About 30% of adults worldwide have MASLD. Rates are increasing as rates of other chronic conditions go up. MASLD is linked with many other health conditions.

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Cardiovascular disease

Cardiovascular disease and MASLD are both associated with high blood sugar, cholesterol, and blood pressure. MASLD is also a separate risk factor for cardiovascular disease.

Type 2 diabetes

More than half of people with type 2 diabetes also have MASLD. High blood sugar and insulin resistance increase the amount of fat stored in the liver.

Sleep apnea

Sleep apnea may worsen insulin resistance and increase inflammation in your body, raising the risk of MASLD.

Hypertension

Around 40% of people with MASLD also have hypertension. Hypertension may increase the risk of progression to MASH.

Obesity

Anyone can develop MASLD, but rates are higher among those with larger bodies. Fat in the stomach area releases more inflammatory proteins, which may increase insulin resistance and lead to more liver fat.

Metabolic syndrome

Metabolic syndrome is a cluster of risk factors for heart disease and type 2 diabetes. MASLD is now being recognized as another symptom and cause of metabolic syndrome.

The goals of MASLD treatment are to:

  • prevent the progression to MASH, where the liver becomes inflamed and damaged
  • manage any health conditions associated with MASLD.

Strategies to manage MASLD will also help manage cardiovascular disease, type 2 diabetes, and metabolic syndrome.

Here are some tips to manage MASLD and other related health conditions:

  • Stay active.
  • Eat a high fiber diet with lots of fruits, vegetables, whole grains, beans, nuts, and seeds.
  • Eat balanced meals on a regular schedule.
  • Include sources of healthy fat such as olive oil, nuts, seeds, fish, and avocado.
  • Avoid or limit alcohol.
  • Limit high sugar foods and drinks such as candy, baked goods, sports drinks, juice, and soda.
  • If you have sleep apnea, use a CPAP machine if recommended by your healthcare professional.
  • Have regular follow-ups with your healthcare team, including blood work, imaging, and other recommended tests.

There are no specific medications to treat MASLD, but medications for conditions related to MASLD may still be part of your treatment plan.

However, if MASLD progresses to MASH, there is a medication that can help reduce liver scarring called resmetirom (Rezdiffra). This may prevent MASH from progressing to cirrhosis. Currently, there is no treatment that can prevent MASLD from progressing to MASH.

Managing high cholesterol, high blood pressure, and high blood sugar may help to prevent the progression to MASH.

It’s possible to live with MASLD for many years. The extra fat in your liver does not always cause problems. In about 20% to 30% of cases, MASLD progresses to MASH when the extra fat starts to damage the liver.

MASLD can be reversed with lifestyle changes. Since MASLD and many metabolic conditions are linked, if you’re diagnosed with one, it’s a good idea to be screened for others.

MASLD develops when extra fat is stored in the liver. MASLD is highly associated with other conditions such as hypertension, type 2 diabetes, and cardiovascular disease.

MASLD can be managed or reversed with many of the same strategies that can help to manage other conditions.

Eating a balanced diet, being active, and avoiding or limiting alcohol are important steps to manage MASLD and related conditions.