Metabolic Dysfunction-Associated Steatotic Liver Disease, or MASLD, is emerging as a significant health concern, particularly in India. Previously known as Non-Alcoholic Fatty Liver Disease (NAFLD), its name was changed to better reflect the condition’s underlying causes. The new term highlights that the disease is a metabolic one, linked to factors such as obesity, diabetes, and high cholesterol. Often referred to as a “silent” disease, MASLD is a liver condition that can progress over time if left unaddressed.
The disease is characterised by the accumulation of excess fat in the liver. While this may not cause immediate symptoms, it can lead to inflammation and, in severe cases, irreversible liver damage. The global prevalence of MASLD is staggering, with a significant portion of the Indian population being affected, particularly middle-aged and older men. Its silent nature is one of its most dangerous aspects, as many people are unaware that they have it in the early stages, making early detection and intervention critical to prevent its progression.
MASLD progression
MASLD exists on a spectrum of severity. It initially presents as simple steatosis, where fat accumulates in the liver without causing significant inflammation. However, if the underlying metabolic issues are not managed, the disease can progress to steatohepatitis, a more severe stage characterised by inflammation of the liver cells. This inflammation can lead to the formation of scar tissue, a process known as fibrosis. As fibrosis becomes extensive, it can lead to cirrhosis, a late-stage condition where the liver is permanently scarred and unable to function properly. At this point, the risk of liver failure and hepatocellular carcinoma (liver cancer) becomes extremely high.
Also Read: Fatty Liver – a silent signal from the body
Screening and diagnosis
Due to its silent nature, proactive screening is essential, especially for individuals with risk factors. These include people who are overweight or obese, have Type 2 diabetes, high blood pressure, or elevated cholesterol levels. While simple blood tests, such as liver function tests, can provide initial clues, a more definitive diagnosis often requires imaging tests such as an ultrasound.
The FibroScan is a highly effective, non-invasive tool used to assess liver health. This procedure uses a special ultrasound to measure liver stiffness (an indicator of fibrosis) and the amount of fat in the liver. It helps doctors stage the disease, and monitor its progression or regression over time, making it an invaluable tool for both diagnosis and management.
Management and treatment
The good news is that MASLD is a highly manageable disease, primarily through lifestyle changes. The cornerstone of treatment is a healthy lifestyle, with the two most impactful changes being diet and exercise.
Weight loss: Even a modest reduction of 7-10% of body weight can significantly reduce fat in the liver and improve its function.
Diet: A healthy diet focusing on whole foods, fruits, vegetables, and lean proteins is crucial. It is also vital to reduce the intake of processed foods, sugary beverages, and unhealthy fats.
Eating habits
Adjusting your diet is a cornerstone of MASLD management. Instead of three large meals, it is recommended that individuals consume 4–5 small meals daily, with 2-3 hour gaps between each. This approach optimises digestion and satiety. To align with MASLD guidelines, it is important to be mindful of cultural dietary staples. For example, instead of high-carb options such as rice and rotis, try shifting to multigrain alternatives such as jowar, ragi, and oats. You should also prioritise vegetable-based dishes.
Hydration is also key. The best choice is water, so ensure you stay adequately hydrated throughout the day. It is vital to avoid sugary sodas and juices, as they lack fibre and contribute to metabolic issues. A practical tip is to eat whole fruits instead of drinking juice, as the fibre is beneficial.
Physical activity
Regular physical activity, including both aerobic exercise and strength training, helps burn calories, improves insulin sensitivity, and reduces liver fat.
Sedentary lifestyles are a major risk factor for MASLD. In fact, prolonged sitting has been called “the new smoking.” To combat this, it is essential to reduce sedentary behaviour, especially in desk jobs. Incorporate Non-Exercise Activity Thermogenesis (NEAT) into the day, such as standing or taking short walking breaks during work. For high-risk groups, such as IT employees, workplace programmes that promote physical activity and healthy eating can be particularly effective.
Sleep and fasting
Sleep hygiene is another important factor. Aim for 7-8 hours of adequate sleep per night to support metabolic health and reduce insulin resistance. It is also crucial to address any sleep disorders such as obstructive sleep apnoea, which is a known risk factor for MASLD.
Finally, consider intermittent fasting (IF) or time-restricted feeding. A practical starting point for MASLD patients, particularly those with obesity or insulin resistance, is a 16:8 or 14:10 method. This means fasting for 14-16 hours and an eating window of 8-10 hours. It is essential to consult a healthcare provider before starting IF, especially for patients with advanced liver disease or other health conditions, to ensure safety.
For some individuals, lifestyle changes may not be enough. In these cases, pharmacological therapies may be used to manage associated conditions, including diabetes and high cholesterol. In extreme cases, where severe obesity is a major contributing factor, bariatric surgery may be considered to achieve significant and sustainable weight loss.
Also Read: Union Health Ministry releases revised operational guidelines for Non-Alcoholic Fatty Liver Disease
A call to action
MASLD is not an inevitable consequence of ageing or genetics; it is a lifestyle disease that can be managed and even reversed. The key is to be proactive. If you have any of the risk factors—obesity, diabetes, or high blood pressure—it is crucial to speak with your doctor about screening for MASLD. By making conscious choices about our diet, exercise, and overall health, we can take control of our liver health and prevent the silent progression of MASLD. The shift in terminology to Metabolic Dysfunction-Associated Steatotic Liver Disease should serve as a wake-up call, highlighting the deep connection between our metabolic health and the well-being of our liver.
This article was first published in The Hindu’s e-book Care and Cure.
(Ashok Chacko is senior consultant and head, department of gastroenterology and liver diseases, Naruvi Hospitals, Vellore. Ashok.c@naruvihospitals.com; E. Rabindranath, consultant, medical gastroenterology, Naruvi Hospitals rabindranath.e@naruvihospitals.com)
