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For our patients who have metabolic-dysfunction associated steatotic liver disease (MASLD), we provide comprehensive care at UC San Diego Health.

What is MASLD? (formerly NAFLD)

The term MASLD covers a range of liver disease progression. When metabolic-dysfunction associated steatotic liver disease moves on to a more severe level of liver injury, it is called metabolic steatohepatitis (MASH). Metabolic steatohepatitis (MASH) has become the most common form of chronic liver disease in the developed world. MASLD/MASH is likely the most common liver disease in the United States and is thought to be related to obesity or diabetes. Estimates of the prevalence of MASLD in adults range from 17% to 46%. MASH has been found in 3-13% of adults, with its prevalence approaching 50% in patients with severe obesity and diabetes.

What is MASH? (formerly NASH)

Metabolic dysfunction-associated steatohepatitis (MASH) is inflammation of your liver caused by excess fat cells in it (steatotic liver disease). Chronic inflammation causes progressive liver damage. MASH resembles hepatitis caused by alcohol use, but it stems from something else. It’s most often associated with overweight, high blood lipids and high blood sugar. Steatohepatitis is an advanced stage of metabolic dysfunction-associated steatotic live diesease (MASLD). Metabolic dysfunction-associated steatotic liver disease (MASLD) is common. Researchers estimate that up to 25% of adults in the U.S. have MASLD, but only 20% of those with MASLD have MASH.

MASH Treatment Options

Because obesity, poor dietary habits, and a sedentary lifestyle predispose to the development of MASH, the primary therapeutic intervention is to address these factors by promoting gradual and sustained weight reduction through a balanced, calorically restricted diet composed of healthy food choices coupled with increased physical activity. Although the benefit of lifestyle modification has not been proven in large rigorous clinical trials, enough data have been accumulated from smaller studies to justify this approach.

Pharmacologic treatments have been sought but none has proved universally efficacious. This may be related to the fact that the histopathological changes seen on liver biopsy currently described as MASH may be the result of multiple pathogenic mechanisms acting in concert to varying degrees. Based on the prevalence and risk of progression of MASH to cirrhosis and cancer, the burden of significant disease is large and drug therapy to prevent or treat MASH is needed. A number of thorough reviews have documented the results of the published drug studies for MASH. The MASH CRN recently published the results of the PIVENS trial; a large, multicenter, placebo controlled randomized trial that showed benefits of both pioglitazone and vitamin E in a subset of patients. Further analyses are underway to determine if any pretreatment clinical or pathological findings predict who might respond to these therapies.

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