MASH and MASLD: Liver Health and Chronic Diseases

Type 2 diabetes:

• About 22.5% of people with MASLD and 43.6% of those with MASH have type 2 diabetes. 
• Nearly 80% of people with MASLD may also have type 2 diabetes.
• Insulin resistance, which is a key marker of type 2 diabetes, leads to increased fat buildup in the liver and the development of MASLD.

Cardiovascular diseases and hypertension (high blood pressure):

• MASLD affects up to 70% of people who have diseases of the heart and blood vessels (also called cardiovascular diseases).
• If you have high blood pressure, it can cause MASLD to worsen faster.
• MASLD adds to plaque buildup in your arteries, raising your risk of heart attacks and strokes.
• People with MASLD may get ischemic heart disease, cardiomyopathy (a disease that weakens heart muscle), and arrhythmias.

Chronic kidney disease:

• About 20% to 50% of people with MASLD also have chronic kidney disease. This may mean that MASLD may make kidney disease worsen faster, even without other risk factors such as hypertension or type 2 diabetes.

Obstructive sleep apnea:

• This is when your breathing becomes irregular or stops during sleep. When it happens, it lowers oxygen levels in your blood and affects vital organs. While there’s no direct link between sleep apnea and MASLD, they share common risk factors such as obesity, insulin resistance, hypertension, type 2 diabetes, metabolic syndrome, and liver problems.

Impact on the Latino Community

Hispanic people in the U.S. are more prone to have complications related to MASLD. It affects almost half of Latino adults, compared to about 40% in other racial groups. In 2014, it affected only 29% of Hispanic people.

Also, 38% of Latino children and young adults between the ages of 12 and 29, particularly Mexican Americans, have been diagnosed with MASLD.

Blanca Lizaola-Mayo, MD, an associate professor of medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine, and medical director of the Liver Transplant Center at the Mayo Clinic in Arizona, explains that Hispanic people carry the PNPLA3 gene mutation, which increases the risk of fat buildup in the liver.

"As Hispanics, we have a gene or genetic predisposition to developing metabolic syndrome and fatty liver disease. This, in combination with the Western diet, which is high in chemicals, preservatives, fructose, and substances that lead to weight gain, results in liver disease," she states.

The Importance of Early Diagnosis

People often link liver disease to alcohol consumption. But you can get these conditions even though you drink very little or not at all. 

MASLD and MASH are challenging to diagnose, and many people are unaware they have them until the inflammation in their liver gets worse. Symptoms such as fatigue, belly discomfort, or pain in the upper right abdomen (belly area) may appear.

Detecting MASLD and MASH early is key to preventing severe complications. Your doctor may recommend several tests, including:

• Blood tests
• Ultrasound or sonogram
• Imaging tests to assess liver stiffness and fibrosis 

Treatment for MASLD and MASH needs to address all the different things involved to prevent serious complications such as cirrhosis or liver cancer. Because of the link between these liver conditions and a higher rate of death from heart disease, it’s important to get early and regular medical screening.

Lifestyle Changes

Adjusting your lifestyle is the key to managing MASLD and keeping it from becoming MASH. Losing 7%-10% of your body weight can help reduce fat buildup and swelling in the liver.

Suggestions for lifestyle changes:

• Quit smoking.
• Avoid alcohol.
• Eat a balanced diet with plenty of fruits and vegetables.
• Eat lean protein.
• Limit your intake of red meat, refined flours, white sugars, and sugary drinks.
• Get regular exercise. 
• Take steps to lower your cholesterol levels.
• Manage diabetes well.
• Review the medicines you take to be sure they don’t hurt your liver.

Healthy Alternatives

Lizaola-Mayo does not recommend natural, alternative, or holistic treatments for MASLD and MASH. She also doesn’t support extreme diets, as they are not sustainable long-term.

According to research, "the Mediterranean diet offers the greatest cardio-metabolic benefits" because it is "high in healthy fats, olive oil, avocado, nuts – all of which have anti-inflammatory properties." Black coffee is also included among beverages shown to help the liver, and she recommends consuming it without sugar or cream.

Medical Interventions

When lifestyle changes aren’t enough, your doctor may recommend prescription treatments. GLP-1 receptor agonists, such as semaglutide, liraglutide, and tirzepatide, can help you lose weight, and lower  inflammation and fat buildup in the liver.

In 2024, the FDA approved resmetirom (Rezdiffra) for treating MASH with moderate to advanced liver fibrosis. This treatment may help reduce liver scarring. You use it along with a healthy diet and regular exercise.

Adopting these lifestyle changes can help you slow the progression of MASLD and reduce symptoms. In some cases, it can even reverse fatty liver disease.

Also, regular screening tests are key for assessing your liver health.

Your Outlook

Both MASLD and MASH are treatable diseases. As Lizaola-Mayo explains, "more medications are being approved by the FDA specifically for the treatment of fatty liver disease."

So it is crucial to "understand this highly prevalent disease in our population, have access to a healthy diet, good medical care, and effective treatments that help us make lifestyle changes. Ultimately, these changes will improve metabolic syndrome and help treat fatty liver disease."

Recap

• MASLD and MASH are liver diseases that can lead to severe complications, such as fibrosis, cirrhosis, or liver cancer. 
• They affect Hispanic people at a higher rate than other groups for social, genetic, and health reasons that include a high rate of obesity and type 2 diabetes. 
• These conditions are connected to illnesses such as hypertension, cardiovascular disease, and kidney damage. 
• Early diagnosis and lifestyle changes can make a difference. Adopt healthy habits, stay informed, and talk to your doctor to prevent and manage these diseases.