What You Need to Know about Metabolic Liver Disease

Your liver is one of the body’s unsung heroes. It filters toxins, stores vitamins and regulates hormones. 

Unlike your heart, brain or lungs, which send distress signals when something is wrong, your liver often remains silent, even when it’s hurting.

That’s why millions of Americans may actually have liver disease and not even know it.

“The liver is often quiet, and it’s called the silent organ for that very reason,” says Gastroenterologist and Hepatologist Mary C. Drinane, MD, of Dartmouth Hitchcock Medical Center (DHMC). “For a lot of people, it's often a surprise to get a liver disease diagnosis.”

'A big misconception’

A healthy liver in adults is about the size of a football. It’s on the right side of your belly, under your rib cage.

A healthy, high-functioning liver weighs about three pounds and contains a small amount of fat. But fat buildup becomes a problem when it exceeds 5% of your liver’s weight.

Two common metabolic liver diseases—metabolic dysfunction-associated steatohepatitis (MASH) and metabolic dysfunction-associated steatotic liver disease (MASLD)—were previously called fatty liver disease by physicians.

“A big misconception is that heavy alcohol consumption is the main factor, or that liver disease only happens to people who are very overweight,” says Ambulatory Care Nurse Heather J. Ryan of DHMC.

Eliminating the stigma 

Until 2023, both diseases had different names. MASLD was non-alcoholic fatty liver disease. MASH was non-alcoholic steatohepatitis, characterized by inflammation and liver cell damage. 

But experts argued the names trivialized the disease and were scientifically inaccurate. Patients sometimes expressed shame being diagnosed with something called “fatty” or connected to alcohol. 

“The term ‘fatty liver’ first appeared back in 1825. The term was coined in France, and fatty liver was called ‘foie gras,’” Drinane explains. “Two years ago, the medical community got rid of the term ‘fatty liver’ because that name really stigmatized the disease.” 

‘Non-alcoholic’ was also removed. 

“Patients would ask, ‘Why is that word ‘alcoholic’ in my disorder if it's not associated with alcohol?’’ she says. “And that was a very fair point.”

Are you at risk?

Risk factors for both liver diseases include diabetes, obesity and high cholesterol. Metabolic liver disease does not have any connection to alcohol, and most people experience no symptoms. 

MASH, a more advanced stage of MASLD, can lead to life-threatening conditions like liver cancer or cirrhosis, which is severe scarring of the liver. 

While MASLD is often less severe, it’s also the leading global cause of liver disease and is becoming one of the most common indicators for a liver transplant. 

Cases of MASLD are also on the rise. Research shows it will affect 122 million adults in the United States by 2050. About six million children have MASLD in the U.S., mainly because of the growing epidemic of childhood obesity. But not everyone with MASLD goes on to develop a severe liver disease. 

Anyone can develop metabolic liver disease, regardless of age, gender or health. You are more at risk with any of the following factors: 

• Have prediabetes or Type 2 diabetes
• Are between the ages of 40 and 60
• Are overweight, obese or have excess weight around your waist
• Have high cholesterol or high triglycerides
• Are post-menopausal
• Are Latino or Asian.

How is liver disease diagnosed and treated?

If you have advanced metabolic liver disease, you might experience abdominal pain, jaundice, fatigue or nausea and vomiting.

It can be difficult to recognize or diagnose. Your medical history, a physical examination and imaging tests or blood tests are needed for a diagnosis. A liver biopsy is necessary in about 10% of patients.

MASH isn't always curable. But early diagnosis and treatment may reverse the condition or keep it from getting worse.

To treat MASH, the U.S. Food and Drug Administration (FDA) approved last year a pill called resmetirom, sold under the brand name Rezdiffra. The medication activates a thyroid hormone receptor that reduces liver fat accumulation.

Managing MASLD is more about lifestyle changes to control or reverse the fat buildup in your liver. Obesity medications and bariatric surgery are also options.

Keeping your liver healthy

Eating well, staying active and avoiding alcohol can all help prevent metabolic liver disease. Experts suggest:

• Avoiding processed foods and sugary foods with high fructose corn syrup, which can lead to fat deposits around your liver
• Opting for healthier fats from seeds, nuts, fish and vegetable oils
• Eating fruits and vegetables to increase your fiber intake
• Avoiding alcohol.  

Your liver is one of your largest organs, second only to your skin. It's a quiet workhorse you can't feel or see, but it’s a vital part of you that deserves attention.