Metabolic Dysfunction-Associated Steatotic Liver Disease
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), previously referred to by many practitioners as Fatty Liver Disease or NonAlcoholic Fatty Liver Disease (NAFLD), is a leading cause of liver disease world-wide that is on the rise, affecting an estimated 30% of the global population at this time.
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), previously referred to by many practitioners as Fatty Liver Disease or NonAlcoholic Fatty Liver Disease (NAFLD) is a leading cause of liver disease world-wide that is on the rise, affecting an estimated 30% of the global population at this time. People with Metabolic Dysfunction-Associated Steatotic Liver Disease have fat deposition on the liver and a cardiovascular problem such as BMI > 25, Hemoglobin A1c > 5.7%, High Blood Pressure, Elevated Triglycerides, or low good cholesterol (low HDL).
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) includes a wide spectrum of different stages of liver disease. Disease ranges from a very benign stage of simple fat deposition on the liver that is not causing liver damage to a severe stage of fat deposition on the liver causing significant inflammation and scarring that can eventually evolve into cirrhosis – an advanced stage of liver scarring that can cause life threatening complications and ultimately necessitate liver transplant. While much research remains to understand where and why people start and progress or regress on this spectrum of disease, data at this time advocates for healthy lifestyle changes that can improve a patient’s current disease status and reduce risk of deadly progression.
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Symptoms
Oftentimes, Metabolic Dysfunction-Associated Steatotic Liver Disease is asymptomatic and incidentally identified. During the work-up of other symptoms, imaging shows fat deposition on the liver in a patient with one of the other cardiovascular risk factors – BMI > 25, Hemoglobin A1c > 5.7%, High Blood Pressure, Elevated Triglycerides, or low good cholesterol (low HDL). Thus, the patient meets criteria for Metabolic Dysfunction-Associated Steatotic Liver Disease. However, the fat deposition on the liver is often just mentioned casually in the comments of an imaging report without further management plans to optimize health. If this is you, we are here to help you make changes to improve your liver health.
Sometimes, patients with Metabolic Dysfunction-Associated Steatotic Liver Disease report right upper quadrant pain or elevated liver enzymes (an abnormal blood test). Oftentimes, practitioners at this point will emphasize the importance of weight loss through healthy diet and exercise to improve the blood test and prevent progression of liver damage. However, these recommendations require behavioral changes that are challenging, and patients are often not provided enough resources to support behavioral changes in our complex world. We are here to help guide you through the different pathways available to help you successfully navigate these behavioral changes in a fun, engaging platform, with the option to create a personalized treatment plan through our counseling sessions.
Metabolic Dysfunction-Associated Steatotic Liver Disease
(MASLD) Treatment
The cornerstone of improving Metabolic Dysfunction-Associated Steatotic Liver Disease and preventing progression involves weight loss through nutritional changes and exercise; losing 3-5% of the total body weight can reduce fat deposition in the liver, and weight loss of greater than 10% total body weight can reduce inflammation and fibrosis. When approaching this conversation with patients, I often start with recommending a goal of 3-5% total body weight loss. If this goal is met, I then encourage patients to strive for a little more – about 10% total body weight loss. For most patients, this is not too much weight. For example, if you weigh 200 pounds, then a weight loss goal of 3-5% of your body weight would be 6 to 10 pounds. I make sure to encourage my patients to be kind to themselves as even this amount of weight loss can be very challenging, and when we are kind to ourselves and others we can achieve much more in an enjoyable way. I also encourage my patients to recognize that they are not alone – check out some available resources with links at the bottom of this post!
When it comes to this weight loss goal, there are many different ways to successfully approach making nutritional and behavioral changes, and the same method will not work for everyone. Below is a general overview with resource links for added detail, and please, sign-up for a counseling session if you would like us to work with you to create a personalized treatment plan. With this in mind, let’s move forward with presenting you nutritional and behavioral changes we recommend with supporting publication links.
When it comes to improving our daily nutrient intake, one of the simplest ways to approach healthy eating involves favoring fresh products over processed products, avoiding foods or beverages with added sugars, and reducing overall caloric intake. The reduced caloric intake may be one of the most important steps – a systematic review with meta-analysis evaluating the use of diet in treating Metabolic Dysfunction-Associated Steatotic Liver Disease identified that higher caloric intake associated with Metabolic Dysfunction-Associated Steatotic Liver Disease.
With this in mind, as you consider trying the following diets, remember the importance of reduced caloric intake.
A Mediterranean Diet
A Mediterranean Diet involves consuming fresh vegetables and fruit, plant based oils, and avoiding red meat, favoring fish instead. Research suggests aiming for your total daily calorie breakdown to be 40% carbohydrates, 35-40% fat with less than 10% being saturated fat, and 20% protein.
A low-fat Diet
A Low-Fat Diet involving reduction of fat consumption to less than 30% of the total calories consumed, with less than 10% being from saturated fat.
A low-sugar Diet
A Low-Sugar Diet involving reduction of free sugar consumption to less than 3% of the total calories consumed.
If adhering to a diet is not your thing, then there are other options!
We have listed below other nutrition recommendations that you could try to incorporate into your day to day routine to improve your liver health.
The following recommendations have been suggested to be helpful in reducing the risk of and/or improving liver disease. These recommendations are not for patients that have cirrhosis (end stage liver scarring).
Coffee
Consider consuming 3 daily cups of unsweetened, black coffee.
Vitamin E
Consume 800 IU daily if you have no history of diabetes or cirrhosis. If you have a history of a bleeding disorder, then I would avoid consumption as vitamin E may carry an increased risk of bleeding.
Silymarin
(An extract of Milk Thistle)
Consider consuming between 420 mg to 700 mg three times a day based on limited data.
L-Carnitine
Consider taking 1 gram after breakfast and dinner daily for up to 24 weeks based on limited data.
Probiotics
There is limited data suggesting improvement of liver disease when correcting a possible underlying gut-microbiome problem. The formulations studied with improvements include VSL #3 as well as other Lactobacillus, Bifidobacterium, Streptococcus, and Enterococcus combinations
Avoid daily fructose
Fructose is often found in fruit juices and sodas and daily consumption associated with increased liver scarring in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease.
Exercise
When it comes to exercise, there are many options out there. Even just breaking up or reducing sedentary moments with physical activity can reduce the risk for Metabolic Dysfunction-Associated Steatotic Liver Disease. Doing 150 minutes of moderate intensity activities a week – about two brisk ten minute walks a day – or 75 minutes of vigorous activity a week can reduce progression of Metabolic Dysfunction-Associated Steatotic Liver Disease.
A recent review with analysis of the existing literature highlights the importance of such exercise – even if you do not lose weight, the benefits you obtain from exercise can significantly reduce liver fat.
Additional Resources
Below are links to Nutrition, Exercise and Behavioral Health Resources identified in a prior research publication by Abbas et al. Please check these out for more information and options!
Nutrition
Resources
Conclusion
Ultimately, Metabolic Dysfunction-Associated Steatotic Liver Disease is on the rise and already burdening an estimated 30% of the worldwide population. On a global scale, taking individual actions to improve health and reduce risk of Metabolic Dysfunction-Associated Steatotic Liver Disease or progression of existing Metabolic Dysfunction-Associated Steatotic Liver Disease is imperative. We hope you find these nutritional and exercise tips helpful, and if you would like a more personalized treatment plan, please reach out!
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