Metabolic dysfunction-associated steatotic liver disease (MASLD)

What is Metabolic dysfunction-associated steatotic liver disease (MASLD)?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health issue, especially in Southeast Asia and the Middle East. It occurs when excess fat accumulates in liver cells, not due to alcohol consumption. MASLD is becoming the commonest cause of liver cirrhosis or hepatocellular carcinoma (HCC) - liver cancer worldwide. It is important to identify patients who are developing progressive scarring of the liver because treatment is available.

What Causes Metabolic dysfunction-associated steatotic liver disease (MASLD)?

The exact cause of MASLD remains unclear. However, studies suggest a combination of genetics, metabolic imbalances, and lifestyle factors contributes to the condition.

Common Causes of Metabolic dysfunction-associated steatotic liver disease (MASLD)

Obesity, especially abdominal (visceral) fat
Insulin resistance is often linked to Type 2 diabetes
High blood sugar levels (hyperglycaemia)
Elevated triglycerides or cholesterol
Genetic predisposition, particularly in those with a family history of similar liver disease

Some individuals develop MASLD even without the typical risk factors, which is why clinical diagnosis is key.

What Are the Symptoms of Metabolic dysfunction-associated steatotic liver disease (MASLD)?

Most individuals with MASLD do not experience symptoms. Symptoms only develop when liver failure has occurred.

Symptoms That May Indicate Liver Cirrhosis Include:

Itchy skin
Abdominal bloating or fluid buildup (ascites)
Shortness of breath
Swelling in the legs or ankles
Red palms or spider veins under the skin
Enlarged spleen
Jaundice (yellowing of the skin and eyes)
Confusing (hepatic encephalopathy)
Internal bleeding (variceal bleeding)

If you experience any of these, it’s essential to consult a liver specialist at SJMC or your nearest hepatology centre.

When to Seek Medical Help?

See a medical professional if you:

Have persistent abdominal discomfort
Experience unexplained fatigue
Notice changes in your skin or eyes, such as yellowing (jaundice)
Have existing metabolic conditions like diabetes or obesity

At SJMC, our liver specialists use advanced diagnostics, including elastography, liver panels, and imaging scans, to detect liver changes early, even before symptoms appear.

Recognising Symptoms? Talk to a Healthcare Provider

Metabolic dysfunction-associated steatotic liver disease (MASLD) can remain silent for years, but the underlying metabolic dysfunction continues to damage liver tissue. By recognising the causes and early warning signs, you can take proactive steps toward liver wellness. If you're at risk, consider booking a liver screening with a hepatologist at a trusted centre like SJMC.

FAQs About Metabolic dysfunction-associated steatotic liver disease (MASLD) Causes and Symptoms

Yes, MASLD can also occur in people with a healthy weight. This is referred to as "lean MASLD" and may be linked to genetics, insulin resistance, or metabolic dysfunction.

Early MASLD often presents with no clear symptoms. Subtle signs such as mild tiredness or vague abdominal discomfort may go unnoticed.

Genetic factors can significantly increase the likelihood of developing MASLD or NASH. People with a family history of liver disease or metabolic disorders may carry genes that predispose them to liver fat accumulation, even in the absence of other risk factors.

Insulin resistance prevents cells from using glucose efficiently, prompting the liver to produce more fat as compensation. Over time, this leads to fat accumulation in liver tissue, increasing the risk of inflammation and scarring if left untreated.

While MASLD is often associated with obesity and poor dietary choices, it can also affect individuals who do not fit this profile. Some people have a genetic tendency to store fat in their liver, even if they maintain a balanced diet and regular exercise. Others may develop MASLD due to underlying metabolic issues, such as insulin resistance or hormonal imbalances. For this reason, it is important for anyone with risk factors like a family history of liver disease or diabetes to be aware of MASLD, regardless of their lifestyle.

MASLD is increasingly being diagnosed in children and teenagers, especially those who are overweight or have metabolic risk factors. Symptoms in young people are often mild or absent, Parents should be alert if their child has risk factors such as obesity, type 2 diabetes, or a family history of liver disease, and discuss screening with their GP or paediatrician if concerned.

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