Metabolic-associated steatotic liver disease
"Metabolic-associated liver disease can progress without symptoms for years, but early detection allows intervention before liver damage becomes irreversible."
DR. CAROLINA PERDOMO ZELAYA
SPECIALIST. ENDOCRINOLOGY AND NUTRITION DEPARTMENT
What is Metabolic-Associated Liver Disease?
Metabolic-associated steatotic liver disease (MASLD) is the new term that replaces non-alcoholic fatty liver disease (NAFLD). It is a condition characterized by the accumulation of fat in the liver in the absence of significant alcohol consumption, closely linked to metabolic syndrome, obesity, and insulin resistance.
MASLD is the most common chronic liver disease worldwide, with a rising prevalence due to increasing rates of overweight and type 2 diabetes. It can progress silently for years, but in some cases, it advances to metabolic-associated steatohepatitis (MASH)—an inflammatory state that raises the risk of liver fibrosis, cirrhosis, and hepatocellular carcinoma.
Medical monitoring is essential for individuals with associated risk factors such as obesity, type 2 diabetes, dyslipidemia, and hypertension. Early detection through imaging tests and specific blood markers enables timely intervention before liver damage becomes irreversible.
At our Clinic, we offer a Metabolic-Associated Liver Disease Screening Program based on blood tests that assess biochemical markers. The goal is to rule out or establish a well-founded suspicion of liver fibrosis, one of the primary complications of this disease, in patients with elevated values.
What are the symptoms of metabolic liver disease?
Symptoms may be nonspecific or absent in early stages
Chronic fatigue
Persistent fatigue is one of the most common symptoms in patients with MASLD. It is due to altered energy metabolism in the liver and the systemic inflammation that accompanies the disease. Fatigue may be mild in early stages, but tends to intensify as the condition progresses.
Discomfort or pain in the right hypochondrium
Some people experience discomfort in the upper right side of the abdomen, where the liver is located. This symptom is usually related to liver enlargement (hepatomegaly) or inflammation of the Glisson's capsule, which lines the organ.
Hepatomegaly
The liver may increase in size due to fat accumulation and inflammation. Although it is usually an incidental finding on imaging studies, in some cases it may cause abdominal fullness or discomfort when the area is pressed.
Alterations in blood tests
Many patients have no obvious symptoms, but show elevations in liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), on routine tests. These alterations may be the first sign of MASLD and require medical evaluation.
Jaundice (in advanced stages)
When the disease progresses to severe liver damage, liver function is compromised and bilirubin may accumulate in the blood, causing yellowing of the skin and eyes. Jaundice usually indicates significant liver involvement.
Generalized pruritus
In some advanced cases, liver dysfunction causes the accumulation of toxic substances in the skin, generating intense and persistent itching. This symptom usually appears in more severe stages of the disease, when there is cholestasis or liver failure.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
Causes of inflammatory liver disease
Metabolic liver disease (MASLD) is a multifactorial pathology influenced by both genetic and environmental factors.
Its main cause is metabolic dysfunction, especially that associated with insulin resistance, which favors excessive fat accumulation in the liver (hepatic steatosis). This lipid accumulation generates oxidative stress and inflammation, which can lead to liver fibrosis and progressive damage.
Risk factors for metabolic liver disease
One of the main risk factors is obesity, particularly abdominal obesity, as visceral adipose tissue releases inflammatory mediators that affect liver function. Likewise, type 2 diabetes and metabolic syndrome are closely related to MASLD, due to altered glucose and lipid regulation.
Other risk factors include dyslipidemia (elevated triglyceride and LDL cholesterol levels), arterial hypertension and sedentary lifestyle. In addition, certain genetic factors, such as polymorphisms in the PNPLA3 gene, may predispose to the disease, even in people without obvious obesity.
How is metabolic liver disease diagnosed?
The diagnosis of MASLD combines biochemical markers, imaging tests and, in some cases, liver biopsy. In blood tests, transaminases (ALT, AST), GGT, alkaline phosphatase and albumin are evaluated, although they may be normal in early stages. Indices such as FIB-4 and NAFLD Fibrosis Score are used to estimate the risk of fibrosis.
Liver elastography (FibroScan®) is a key non-invasive technique for measuring liver stiffness and detecting advanced fibrosis or cirrhosis. When results are uncertain or metabolic steatohepatitis (MASH) is suspected, liver biopsy is used to directly assess inflammation and the degree of liver damage.
These tools allow an accurate diagnosis and help determine the severity of the disease for appropriate treatment.
How is metabolic liver disease treated?
The treatment of MASLD is based on lifestyle changes, as there is no drug specifically approved for this disease. The main strategy is weight loss, recommending a 7-10% reduction in body weight to reduce liver fat and slow progression to fibrosis. This is achieved through a balanced diet, low in refined sugars and saturated fats, together with regular exercise.
In patients with insulin resistance or dyslipidemia, drugs such as metformin, GLP-1 agonists or pioglitazone may be indicated. Therapies aimed at reducing inflammation and liver fibrosis are also being studied.
Management should be personalized and, in advanced cases with cirrhosis or liver failure, specialized follow-up is required to evaluate options such as liver transplantation.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Endocrinology and Nutrition of the
of the Clínica Universidad de Navarra
The Department is organized into care units with specialists totally dedicated to the study, diagnosis and treatment of this type of disease.
We work with established protocols, which ensure that all diagnostic tests to be performed are done in the shortest time possible and that the most appropriate treatment is started as soon as possible in each case.
Organized in care units
- Obesity Area.
- Diabetes Unit.
- Thyroid and Parathyroid Disease Unit.
- Osteoporosis Unit
- Other diseases: e.g. Cushing's syndrome.
Why at the Clinica?
- European Center of Excellence in the diagnosis and treatment of Obesity.
- Team of specialized nurses at the Day Hospital of Endocrinology and Nutrition.
- We have a Metabolic Research Laboratory of international prestige.
Our team of professionals
