Millions in the US Face Hidden Liver Disease: Key Facts Revealed

A little-known but increasingly prevalent liver condition is impacting millions across the United States. Known as metabolic dysfunction–associated steatotic liver disease (MASLD), this ailment can develop silently, often going unnoticed until significant damage occurs. According to a recent review in the *Journal of the American Medical Association* (JAMA), MASLD now affects approximately 30% to 40% of the adult population globally, with around one in three adults in the U.S. impacted.

Dr. Leana Wen, an emergency physician and adjunct associate professor at George Washington University, explains that MASLD arises when excessive fat accumulates in the liver, primarily in individuals with underlying metabolic issues such as obesity and type 2 diabetes. Unlike conditions linked to heavy alcohol consumption, MASLD can develop in individuals regardless of their alcohol intake. The rise in obesity and diabetes rates has contributed to the growing prevalence of MASLD.

Understanding Symptoms and Diagnosis

The challenge with MASLD is that it often presents no symptoms in its early stages. Dr. Wen notes that while some individuals may experience vague feelings of fatigue or discomfort in the upper right abdomen, these signs are typically nonspecific and easy to overlook. More pronounced symptoms, including yellowing of the skin or eyes and swelling in the legs or abdomen, emerge only when the disease has progressed significantly.

Diagnosis often occurs through routine blood tests that reveal abnormal liver enzyme levels or through imaging studies, such as abdominal ultrasounds, that indicate a fatty liver. Doctors look for key metabolic risk factors, including excess weight, diabetes, and high cholesterol, to confirm a diagnosis. Dr. Wen emphasizes the importance of early detection, urging primary care clinicians to consider liver health in patients with these risk factors.

Risk Factors and Treatment Options

MASLD is most commonly diagnosed in adults with metabolic risk factors, particularly those who are overweight or obese. However, individuals who appear to have a healthy weight can also develop the condition. The disease is more frequently seen in older adults, especially those over 50, and nearly 10% of children aged 2 to 19 are also affected, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Although MASLD can lead to severe complications, such as liver failure or cancer, there is hope for improvement. Dr. Wen reports that weight loss is the cornerstone of treatment, significantly reducing liver fat and inflammation. Regular physical activity is also crucial for enhancing insulin sensitivity. Recently, the U.S. Food and Drug Administration (FDA) approved two medications—Rezdiffra (resmetirom) and Wegovy (semaglutide)—for the more advanced form of MASLD, known as metabolic dysfunction–associated steatohepatitis (MASH), which includes liver inflammation and scarring.

Despite the advancements in treatment, Dr. Wen cautions that there is still no comprehensive cure for MASLD. Early diagnosis and intervention remain vital in preventing disease progression.

To protect liver health, individuals are encouraged to maintain a healthy weight, engage in regular exercise, and adopt a balanced diet rich in lean proteins, whole grains, and vegetables while minimizing added sugars and ultra-processed foods. For those with existing conditions such as type 2 diabetes or high cholesterol, collaborating with healthcare providers to monitor liver health is essential. Simple blood tests can help identify individuals who may benefit from further evaluation, and precautions such as avoiding excessive alcohol consumption and ensuring hepatitis vaccinations are up to date can further support liver health.

Understanding MASLD and its implications is crucial as this condition continues to affect a significant portion of the population. Awareness and proactive health measures can play a key role in managing and potentially reversing the disease.