Fatty Liver Disease Gets a New Name and a Growing Concern in Australia
Fatty liver disease, a condition where excess fat accumulates in the liver, is a significant health issue globally and in Australia. The liver, our body’s vital filter, plays a crucial role in cleaning our blood, storing energy, and processing nutrients. When fat builds up excessively, it can impair the liver’s function, leading to severe health complications.
A New Identity: From NAFLD to MASLD
Previously known as Non-Alcoholic Fatty Liver Disease (NAFLD), this condition has now been rebranded as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). The name change reflects a better understanding of its underlying causes, which are strongly linked to metabolic issues such as obesity, type 2 diabetes, high blood pressure, and other metabolic disturbances. This shift in terminology aims to highlight the systemic nature of the disease and its connection to broader health challenges.
A more severe form of the condition, where fat accumulation is accompanied by inflammation and scarring of the liver, is now termed Metabolic dysfunction-Associated Steatohepatitis (MASH).
The Widespread Impact of MASLD in Australia
While specific Australian statistics are still emerging, global and US data indicate a concerning prevalence. Research suggests that approximately one-third of adults in the United States currently have MASLD. Projections indicate that without significant advancements in prevention and treatment, this figure could rise to as high as 40% by 2050. The more serious MASH form affects an estimated 5% to 6% of adults, with a potential for future increases.
Crucially, many individuals with MASLD also develop liver scarring, known as fibrosis, or even cirrhosis. This progression significantly elevates their risk of developing liver cancer.
Recognising the Signs: Symptoms of MASLD
Often, MASLD presents with no discernible symptoms, particularly in its early stages. However, when symptoms do appear, they can be subtle and easily overlooked. These may include:
- Fatigue: A persistent feeling of being extremely tired.
- Abdominal Discomfort: Mild pain or a sense of unease on the right side of the abdomen.
- General Malaise: Feeling generally unwell or lacking energy.
As the disease progresses to more severe forms like MASH, more pronounced symptoms can emerge:
- Fluid Retention: Swelling in the abdomen (ascites) or legs.
- Jaundice: A yellowing of the skin and the whites of the eyes, indicating impaired liver function.
- Bleeding and Bruising: An increased tendency to bruise or bleed easily, due to a reduced production of clotting factors by the liver.
- Cognitive Changes: Confusion or difficulty concentrating, which can be a sign of hepatic encephalopathy, a complication of advanced liver disease.
- Stool Colour Changes: Alterations in the colour of the stool, which can be indicative of bile duct obstruction or other liver-related issues.
Diagnosing MASLD: A Multifaceted Approach
Diagnosing MASLD involves a thorough assessment by healthcare professionals, focusing on detecting fat in the liver and identifying signs of liver stress or damage, particularly in individuals with pre-existing risk factors. The diagnostic process typically aims to rule out other conditions that can cause abnormal liver enzymes, such as viral hepatitis.
A comprehensive workup may include:
- Blood Tests:
- These are essential for evaluating liver enzymes, which can indicate inflammation or damage.
- They also help to identify and exclude other potential causes of abnormal liver function.
- Imaging Scans:
- Ultrasound: A non-invasive initial assessment to visualise the liver’s structure and detect fat accumulation.
- CT or MRI Scans: Provide more detailed images of the liver, allowing for a better assessment of its overall architecture and the identification of more advanced stages of disease, such as scarring.
- Liver Stiffness Tests:
- Techniques like vibration-controlled transient elastography (VCTE), commonly known as FibroScan, are used to estimate the degree of scarring in the liver. This is a crucial step in differentiating between simple fatty liver and more advanced fibrosis.
- Liver Biopsy:
- In some instances, if the diagnosis remains unclear or further detailed information about the liver tissue is required, a liver biopsy may be performed. This involves taking a small sample of liver tissue for microscopic examination.
The Role of the Fib-4 Score
Doctors also utilise the Fib-4 score as a valuable tool for risk stratification. This simple calculation is based on a patient’s age and results from common blood tests, including liver enzymes and platelet counts. The Fib-4 score helps clinicians to:
- Identify Low-Risk Individuals: A Fib-4 score of less than 1.3 generally indicates a low risk of significant liver scarring, meaning less intensive follow-up may be needed.
- Determine Need for Further Investigation: A higher Fib-4 score suggests a greater probability of advanced liver scarring, prompting a referral to a liver specialist for more in-depth evaluation and management.
Identifying Those at Risk
Several factors increase an individual’s susceptibility to developing MASLD. If you experience any of the following, it’s advisable to discuss your liver health with your doctor:
- Excess Body Weight: Being overweight or obese is a primary risk factor.
- Type 2 Diabetes: This metabolic disorder is strongly associated with MASLD.
- Hypertension: High blood pressure can contribute to the development of fatty liver disease.
- Dyslipidaemia: Elevated levels of cholesterol or triglycerides in the blood.
- Insulin Resistance or Metabolic Syndrome: These conditions, often occurring together, are key drivers of MASLD.
- Family History: A genetic predisposition to liver disease can increase risk.
It’s important to note that MASLD can affect both adults and children, highlighting the need for awareness across all age groups.
Treatment Strategies for MASLD and MASH
Currently, there is no single cure for MASLD. However, significant improvements in liver health are achievable through a combination of lifestyle modifications and, in some cases, approved medications.
Lifestyle Modifications: The Cornerstone of Treatment
The primary approach to managing MASLD involves making sustainable lifestyle changes:
- Healthy Diet:
- Focus on whole, unprocessed foods.
- Reduce intake of processed foods, sugary drinks, and unhealthy fats.
- Regular Physical Activity:
- Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
- Incorporate resistance training two to three times per week.
- Weight Management:
- Achieving and maintaining a healthy weight is crucial for reducing liver fat.
- Managing Chronic Conditions:
- Effective control of diabetes and cholesterol levels is vital.
- Alcohol Consumption:
- Avoiding excessive alcohol intake is essential, as alcohol can exacerbate liver damage.
Approved Medications for MASH
For individuals diagnosed with MASH, characterised by liver inflammation and scarring, the US Food and Drug Administration (FDA) has approved two medications:
- Rezdiffra (resmetirom):
- This medication was the first to be specifically approved for treating MASH in adults with moderate to advanced fibrosis.
- It works by reducing fat accumulation and inflammation within the liver.
- Wegovy (semaglutide):
- While initially developed for weight loss, Wegovy is now approved for treating MASH in adults with moderate to advanced liver fibrosis, when used in conjunction with diet and exercise.
- It can contribute to improved liver health and support weight reduction efforts.
It is critical to understand that these medications are intended for individuals with the more severe form of fatty liver disease (MASH) and not for simple MASLD without significant scarring.
The Importance of Early Detection and Proactive Care
The silent nature of MASLD in its early stages underscores the importance of regular health check-ups, especially for individuals with identified risk factors. Early detection, coupled with prompt implementation of lifestyle changes, can significantly slow down or even reverse liver damage. Prioritising liver health through proactive monitoring and healthy habits is fundamental to maintaining overall well-being.
About the Expert:
Dr. Meena B. Bansal, MD, FAASLD, is a leading authority in the field of liver diseases. She serves as the system chief of the Division of Liver Diseases for the Mount Sinai Health System and is a Professor of Medicine at the Icahn School of Medicine. Dr. Bansal spearheads the institution’s MASH Center of Excellence, overseeing cutting-edge clinical trials and research. She also contributes as an associate director of the Mount Sinai Institute for Liver Research, dedicated to advancing the understanding and treatment of liver disease.
What This Means for You
The evolving understanding of fatty liver disease, now known as MASLD, highlights its prevalence and the potential for serious health consequences. Many individuals may not experience any symptoms in the initial stages. Therefore, regular medical check-ups and the adoption of a healthy lifestyle – encompassing a balanced diet and consistent physical activity – are paramount. These proactive measures can help identify potential liver issues early, preventing the progression to more severe damage and safeguarding your long-term health.
