Metabolic dysfunction–associated steatotic liver disease

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Metabolic dysfunction–associated steatotic liver disease
Synonyms	MASLD
Pronounce	N/A
Specialty	N/A
Symptoms	Often asymptomatic, fatigue, right upper quadrant pain
Complications	Cirrhosis, liver cancer, cardiovascular disease
Onset	Typically in adulthood
Duration	Chronic
Types	N/A
Causes	Metabolic syndrome, obesity, type 2 diabetes, dyslipidemia
Risks	Insulin resistance, hypertension, sedentary lifestyle
Diagnosis	Liver function tests, ultrasound, liver biopsy
Differential diagnosis	Alcoholic liver disease, viral hepatitis, autoimmune hepatitis
Prevention	Weight loss, dietary changes, physical activity
Treatment	Lifestyle modification, medication, bariatric surgery
Medication	N/A
Prognosis	Variable, depends on stage and treatment
Frequency	Increasing worldwide, common in developed countries
Deaths	N/A

Stage of liver damage

File:Non-alcoholic fatty liver disease.webm

Mallory body high magnification

Histopathology of a ballooning hepatocyte

Metabolic dysfunction–associated steatotic liver disease (MAFLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a type of liver disease characterized by the accumulation of fat in the liver of people who drink little to no alcohol. It is closely associated with metabolic syndrome, which is why the name was changed to reflect its metabolic dysfunction origin.

Definition

MAFLD is defined by the presence of steatosis in patients who have overweight or obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation. The term MAFLD can be applied to both non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH).

Epidemiology

MAFLD is the most common liver disorder in Western countries, affecting about 25% of the population. It is also increasingly recognized in developing countries due to the global epidemic of obesity and type 2 diabetes.

Pathophysiology

The pathogenesis of MAFLD is complex and involves multiple parallel hits, including insulin resistance, secretion of pro-inflammatory cytokines, oxidative stress, and mitochondrial dysfunction. The disease progresses from simple steatosis to steatohepatitis, fibrosis, and eventually cirrhosis and hepatocellular carcinoma.

Diagnosis

Diagnosis of MAFLD is usually made by imaging studies such as ultrasound, CT scan, or MRI, which can detect fat in the liver. Liver biopsy is the gold standard for diagnosing MAFLD, but it is invasive and has potential complications.

Treatment

The mainstay of treatment for MAFLD is lifestyle modification, including diet, exercise, and weight loss. Pharmacological therapies are also available, but their long-term efficacy and safety are still under investigation.

Prognosis

The prognosis of MAFLD varies depending on the stage of the disease. Patients with simple steatosis have a relatively benign course, while those with NASH, fibrosis, or cirrhosis have a higher risk of liver-related morbidity and mortality.

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  NASH stage 6

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  NASH stage 2

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  Histopathology of inflammatory foci in MASH

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  NAFLD liver progression

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  MRI Liver steatosis

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  Human liver biopsy sample

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  Non-alcoholic fatty liver disease

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  Bariatric surgery in NAFLD

See also

• Liver disease
• Metabolic syndrome
• Obesity
• Type 2 diabetes

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