Metabolic dysfunction-associated steatotic liver disease (MASLD)

Diagnosis of Metabolic dysfunction-associated steatotic liver disease (MASLD)

As MASLD typically presents with few or no symptoms, it is often identified incidentally when routine blood tests show elevated liver enzymes, prompting further evaluation.

Common Diagnostic Methods

Blood tests

Used to assess liver function and detect other conditions:

Liver function test
Full blood count (FBC)
Fasting blood sugar and HbA1C (to assess diabetes risk)
Lipid profile (triglycerides and cholesterol)
Screening for hepatitis B and C
FIB-4 - Your doctor should assess you for the FIB-4 score to determine your risk for significant liver fibrosis.

Imaging studies

Non-invasive scans help visualise liver fat and fibrosis:

Abdominal ultrasound: First-line tool for detecting fatty liver
Transient elastography (FibroScan): Measures liver stiffness, fibrosis staging and fat quantification.
MRI or CT scan: Advanced imaging might be useful

Liver biopsy

In complex or uncertain cases, a liver biopsy may be needed to confirm (MASH), exclude other causes of liver diseases and determine the extent of inflammation and fibrosis. It involves extracting a small tissue sample from the liver using a needle for microscopic analysis. While considered the gold standard, it is reserved for selected cases due to its invasive nature.

Treatment Options for Metabolic dysfunction-associated steatotic liver disease (MASLD)

There is no single medication that treats all stages of MASLD, but an individualised, multidisciplinary approach can help reverse liver fat buildup, reduce inflammation, and slow disease progression.

First-Line Treatment: Lifestyle Modification

Weight loss
A reduction of 5–10% of body weight can significantly improve liver fat levels and inflammation. In some cases, medication and bariatric (weight-loss) surgery may be considered.
Dietary changes
A Mediterranean-style diet rich in vegetables, whole grains, and lean proteins is often recommended. Patients are advised to avoid sugary drinks, processed foods, and trans fats. It's advisable to consult with a dietitian or nutritionist to improve liver health.
Regular exercise
Aim for at least 150 minutes of moderate activity per week, such as brisk walking or cycling. It is also important to do routine exercises.
Manage comorbidities
Treat related conditions like Type 2 diabetes, high blood pressure, and dyslipidaemia with guidance from your healthcare provider.

Emerging Treatments

While lifestyle changes remain the cornerstone of management, SJMC stays up to date with the latest developments:

Resmetirom: Recently approved in the US for patients with significant liver fibrosis.
Semaglutide: Also approved for patients with significant liver fibrosis

How to Prepare for Your Appointment

If you're being evaluated for MASLD, especially at a specialist liver centre like SJMC, it’s helpful to:

Track your symptoms, even if mild
Bring a list of all medications and supplements
Review recent blood tests or scans
Prepare questions about your condition and treatment options

You may be referred to a hepatologist, a doctor who specialises in liver diseases, for further management.

What to Expect From Your Doctor

When you visit your healthcare provider for a possible liver-related condition such as MASLD, your doctor will perform a thorough evaluation. This may include questions about your symptoms, lifestyle habits, and medical history to help guide diagnosis and treatment.

Common Questions Your Doctor May Ask

Whether you’ve noticed signs like jaundice (yellowing of the eyes or skin), abdominal discomfort, or bloating around the waistline.
Any prior blood or imaging tests that revealed abnormal liver enzymes or other related issues.
Your alcohol consumption habits, even if minimal, to rule out alcohol-related liver disease.
A list of medications, supplements, or traditional remedies you are currently taking, including over-the-counter drugs.
Whether you have been previously diagnosed with hepatitis or any other liver conditions. Track your symptoms, even if mild
Your family history of liver disease, metabolic conditions, or genetic risk factors.

Providing accurate and complete answers helps your physician determine the best approach for further testing, such as a liver ultrasound, elastography, or possibly a biopsy, especially if you are being referred to a hepatologist or gastroenterologist for further care.

At Subang Jaya Medical Centre (SJMC), our gastroenterologists are equipped with advanced diagnostics and multidisciplinary support to guide your liver health journey from initial assessment to treatment and lifestyle management.

FAQs About Nonalcoholic Fatty Liver Disease Diagnosis & Treatment

MASLD is often first identified during routine health screenings when blood tests show raised liver enzymes or imaging scans (such as ultrasound) reveal excess liver fat. Many cases are discovered incidentally during checks for other health issues, as the condition typically causes no symptoms in its early stages.

While blood tests and imaging can suggest fatty liver, a liver biopsy is currently the most accurate method to confirm nonalcoholic steatohepatitis (NASH) and assess liver damage severity, including inflammation and fibrosis.

Yes, gradual weight loss through dietary changes and physical activity can reduce liver fat, inflammation, and fibrosis in the early stages of MASLD. Losing 7–10% of body weight is often recommended.

Yes, untreated MASLD can lead to more severe liver problems, including non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, or even liver cancer.

Yes, it is possible to have MASLD even if your liver blood tests are within the normal range. Some people with fatty liver do not show abnormal results even when the disease progresses. That’s why doctors often use a combination of blood tests, imaging scans, and a review of your risk factors to make a diagnosis.

If you have risk factors like obesity, diabetes, or a family history of liver disease, it is sensible to discuss liver screening with your GP, even if your blood tests are normal.

Sometimes, fatty liver is discovered incidentally during imaging for unrelated reasons, such as an abdominal ultrasound or CT scan. If this happens, your doctor will arrange further tests to assess your liver health and check for any signs of inflammation or fibrosis.

You may be referred to a liver specialist for further evaluation, advice on lifestyle changes and monitoring. Early detection, even if accidental, is an opportunity to take steps to protect your liver and prevent progression.

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