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# Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)

Fat builds up in the liver in people with obesity, diabetes or other metabolic risks. Usually silent, it can progress to scarring, cirrhosis and liver cancer.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Liver](https://durgical.com/en/anatomy/liver/)
- [Portal vein](https://durgical.com/en/anatomy/hepatic-portal-vein/)
- [Hepatic veins](https://durgical.com/en/anatomy/hepatic-veins/)
- [Pancreas](https://durgical.com/en/anatomy/pancreas/)
- [Spleen](https://durgical.com/en/anatomy/spleen/)

## In the clinical exam

- [Palpation of the liver and spleen](https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/)
- [Portal hypertension and the signs of chronic liver disease](https://durgical.com/en/clinical-exam/portal-hypertension-and-the-signs-of-chronic-liver-disease/)

## Why it happens

- [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/)
- [Fatty change (steatosis)](https://durgical.com/en/general-pathology/fatty-change/)
- [Obesity: leptin, adipokines and its consequences](https://durgical.com/en/general-pathology/obesity-leptin-adipokines-and-its-consequences/)
- [Liver regeneration](https://durgical.com/en/general-pathology/liver-regeneration/)
- [Islets and insulin: secretion and actions](https://durgical.com/en/physiology/islets-and-insulin-secretion-and-actions/)
- [Fatty acid synthesis (lipogenesis)](https://durgical.com/en/biochemistry/pathways/fatty-acid-synthesis/)

## Show 2 more

- [VLDL (very-low-density lipoprotein)](https://durgical.com/en/biochemistry/topics/vldl/)
- [Liver: lobule, acinus, hepatocytes, sinusoids, Kupffer cells](https://durgical.com/en/histology/liver-lobule-acinus-hepatocytes-sinusoids-kupffer-cells/)

## What it is

Hepatic steatosis in a person with at least one cardiometabolic risk factor and no other cause of fat in the liver. It was formerly called non-alcoholic fatty liver disease (NAFLD); its inflammatory form is MASH (formerly NASH).

## Who gets it

The most common chronic liver disease worldwide, affecting roughly a third of adults, and Latin America reports some of the highest prevalences. It is rising in Colombia with obesity and type 2 diabetes, and it is becoming a leading cause of cirrhosis, liver cancer and transplantation.

## Causes

- Insulin resistance with overweight or abdominal obesity
- Type 2 diabetes or prediabetes
- Hypertension, high triglycerides or low HDL cholesterol
- Genetic variants (for example PNPLA3) that raise susceptibility
- MetALD: MASLD plus moderate alcohol intake, a separate overlap category

## Risk factors

- Obesity, especially central obesity
- Type 2 diabetes
- Metabolic syndrome and dyslipidaemia
- Sedentary lifestyle and diets high in fructose and ultra-processed foods
- Polycystic [ovary](https://durgical.com/en/anatomy/ovary/) syndrome, obstructive sleep apnoea and hypothyroidism

## Pathophysiology

Insulin resistance increases the release of free fatty acids from adipose tissue and de novo lipogenesis in the liver, so triglycerides accumulate in hepatocytes. Lipotoxicity, oxidative stress and gut-derived signals cause hepatocyte injury and inflammation (MASH), which activates stellate cells and lays down fibrosis that can progress to cirrhosis.

## Classification

- MASL: steatosis without significant inflammation
- MASH: steatohepatitis with hepatocyte ballooning and inflammation
- Fibrosis stage F0 to F4 (F4 is cirrhosis); fibrosis stage best predicts outcome
- MetALD: overlap with moderate alcohol intake

## Symptoms and signs

- Usually no symptoms; often found by raised liver enzymes or on ultrasound
- Fatigue
- Vague discomfort in the right upper quadrant
- Mild hepatomegaly
- Signs of cirrhosis in advanced disease (jaundice, ascites, spider angiomas)

## Red flags

- Signs of decompensated cirrhosis: jaundice, ascites, confusion or GI bleeding
- Low platelet count suggesting advanced fibrosis and portal hypertension
- A new liver mass on imaging
- Unexplained weight loss

## Diagnosis

**Clinical**
Steatosis plus at least one cardiometabolic criterion (BMI or waist, glucose or diabetes, blood pressure, triglycerides, HDL), with alcohol intake and other [liver](https://durgical.com/en/anatomy/liver/) diseases assessed.

**Tests**
Liver enzymes (ALT often higher than AST, but may be normal), lipid profile, HbA1c, platelets; viral hepatitis serology and other tests to exclude other causes. Non-invasive fibrosis scores such as FIB-4 stratify risk; biopsy is reserved for uncertain cases.

**Imaging**
Ultrasound shows a bright (hyperechoic) liver. Transient elastography or MR elastography measures stiffness to stage fibrosis; MRI proton density fat fraction quantifies fat.

## Differential diagnosis

- Alcohol-related liver disease
- Chronic viral hepatitis B or C
- Drug-induced steatosis (corticosteroids, amiodarone, methotrexate, tamoxifen)
- Wilson disease and haemochromatosis
- Autoimmune hepatitis

## Goal of treatment

Reduce liver fat, inflammation and fibrosis through weight loss and metabolic control, and lower cardiovascular risk, which is the main cause of death.

## Treatment

**Lifestyle**
Gradual sustained weight loss through a healthier diet (for example a Mediterranean pattern) and regular exercise; around 7 to 10 percent of body weight improves inflammation and fibrosis. Limiting or avoiding alcohol.

**Medical**
Treatment of diabetes, dyslipidaemia and hypertension; GLP-1 receptor agonists, pioglitazone and statins are used in selected patients. Thyroid hormone receptor-beta agonists and GLP-1 receptor agonists are approved in some countries for MASH with significant fibrosis.

**Surgical**
Metabolic (bariatric) surgery in selected people with severe obesity.

**Follow-up**
Periodic fibrosis assessment; people with cirrhosis need ultrasound surveillance for liver cancer and screening for varices.

## Complications

- Progression to MASH, advanced fibrosis and cirrhosis
- Hepatocellular carcinoma, which can arise even without cirrhosis
- Cardiovascular disease, the main cause of death
- Higher risk of type 2 diabetes and chronic [kidney](https://durgical.com/en/anatomy/kidney/) disease

## Prognosis

Most people with simple steatosis do not progress to cirrhosis, but MASH with fibrosis can. Fibrosis stage is the strongest predictor of liver-related outcomes, and cardiovascular disease causes most deaths.

## Prevention

- Maintaining a healthy weight and regular physical activity
- Limiting sugar-sweetened drinks and ultra-processed food
- Screening for fibrosis in people with type 2 diabetes or obesity with other risk factors

## Test yourself

Think of the answer, then tap the question to see it.

## What replaced the term NAFLD in 2023?

Metabolic dysfunction-associated steatotic liver disease (MASLD); NASH became MASH.

## Which histological feature best predicts outcomes in MASLD?

The stage of fibrosis.

## What is the typical aminotransferase pattern in MASLD?

Mild elevation with ALT usually higher than AST; an AST/ALT ratio above 2 suggests alcohol-related disease.

## Which non-invasive score is used first to stratify fibrosis risk?

FIB-4 (age, AST, ALT and platelets), followed by elastography if it is not low.

## What is the leading cause of death in people with MASLD?

Cardiovascular disease.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/)

## Related conditions

- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Metabolic syndrome](https://durgical.com/en/conditions/metabolic-syndrome/)
- [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Alcoholic liver disease (biochemistry)](https://durgical.com/en/conditions/alcoholic-liver-disease/)
- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Steatotic Liver Disease | Fatty Liver Disease | MedlinePlus](https://medlineplus.gov/fattyliverdisease.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Source: https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/