(non″al″kŏ-hol′ik)
ABBR: MASLD Fatty infiltration of the liver in patients who are not infected with hepatitis C virus, are not alcoholic, are not taking medications that make fat accumulate in the liver, and are not genetically predisposed to fatty infiltration of the liver. This syndrome has been re-named metabolic dysfunction-associated steatotic liver disease (MASLD) by the American Association for the Study of Liver Diseases.

INCIDENCE
It affects roughly 32% of adults, with significant geographic, ethnic, gender, and national variation. Obesity, metabolic syndrome, type 2 diabetes mellitus, hypothyroidism, sleep apnea, and polycystic ovaries are all associated.

CAUSES
Obesity, metabolic syndrome, type 2 diabetes mellitus (DM), hypothyroidism, sleep apnea, and polycystic ovaries all are associated with MASLD.

SYMPTOMS AND SIGNS
Most patients are asymptomatic and unaware of their condition.

DIAGNOSIS
Abnormal liver function tests, such as elevated levels of aspartate aminotransferase or alanine aminotransferase in the blood, often prompt an evaluation for hepatitis. If viral hepatitis and other forms of liver disease can be excluded with testing, the appearance of a fatty liver on ultrasound, or a liver biopsy showing fatty infiltration of the liver is used to diagnose MASLD. A liver biopsy reveals MASLD when more than 5% of hepatocytes contain fatty deposits.

PREVENTION
Weight loss of about 10% of body weight improves MASLD.

TREATMENT
Lifestyle modifications (prudent diet, exercise, weight loss, and limitations on alcohol intake) and bariatric surgery favorably affect MASLD. No drugs are formally approved for MASLD treatment, but some antidiabetic agents may provide benefit.

IMPACT ON HEALTH
Unmanaged MASLD can progress to cirrhosis; progression of the disease is relatively slow, typically over decades rather than years.

PATIENT CARE
Consultations with nutritionists, physical therapists, and gastroenterologists can motivate patients to lose weight and avoid adverse consequences of MASLD. Consultation with a liver specialist is recommended, especially for patients with evidence of fibrosis of the liver (those with a high FIB-4 score) or abnormal liver stiffness on elastography.