Diabetes and obesity can damage the liver to the point of failure – but few people know their risk of developing liver disease

By Madona Azar, UMass Chan Medical School

Liver disease is frighteningly common worldwide.

Metabolic dysfunction-associated steatotic liver disease, or MASLD, is an umbrella term describing conditions related to a buildup of fat in the liver. Formerly known as nonalcoholic fatty liver disease, this condition affects 1 in 4 people worldwide. Among those with type 2 diabetes, insulin resistance, obesity or all three, the prevalence of MASLD increases to 3 in 4 people.

As a diabetologist, the possibility of liver disease is on my mind every time I see a patient. Understanding your risk of developing this common yet underrecognized condition is essential to treating it.

What is MASLD?

MASLD is a complex disorder with both environmental and genetic contributions. In its early stages, liver cells accumulate fat in a process called steatosis. Major sources of this fat include adipose tissue as well as fatty acids the liver makes in response to insulin resistance and excess caloric intake. This fat accumulation can enlarge the liver and interfere with its normal functioning.

Over time, fatty acids activate enzymes, which can produce toxic byproducts capable of causing liver cell injury, inflammation and scarring. This condition is better known as MASH, or metabolic dysfunction-associated steatohepatitis. Progression to MASH is more common in the presence of other risk factors such as type 2 diabetes, insulin resistance and metabolic syndrome.

Left unaddressed, MASLD and MASH can progress to liver scarring, failure and, in some cases, cancer. They also increase risk of death from cardiovascular disease and liver-related complications.

In the U.S., MASH is the leading cause of liver transplants due to hepatic cancer among women and in those 65 and older. It is also on track to overtake hepatitis B and C as the main reason people develop liver cancer and thus need a liver transplant.

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