Frequently asked questions
Find answers to common questions about MASH (metabolic dysfunction–associated steatohepatitis) and liver health so you can SPEAK UP, SPEAK LOUD, and SPEAK NOW with confidence.
Understanding MASH
MASH is an advanced form of fatty liver disease, which is associated with excessive fat buildup in the liver. Eventually, this excess fat can trigger inflammation, damaging liver cells. This inflammation and damage indicates that fatty liver disease has progressed to MASH. If you think you could be at risk for MASH, talk to your health care professional about whether you should be screened.
Learn more about how fatty liver disease progresses to MASH.
AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are 2 enzymes found primarily in the liver. When a blood test shows sustained higher than normal levels of AST and ALT, it can indicate a problem with the liver, such as MASH.
If your bloodwork shows consistently elevated/increased liver enzymes such as AST or ALT, don't hesitate to ask your health care professional about whether you should be screened.
Your liver doesn't always let you know when something is wrong, like some organs do. Symptoms of fatty liver disease or MASH can be vague, nonspecific, or even absent. Some people who reported symptoms prior to receiving a diagnosis of MASH experienced fatigue, nausea, loss of appetite, abdominal pain, and swelling in the abdomen.
Understanding the risk factors for MASH is the best way to know when it’s time to talk to your health care professional about whether you should be screened for MASH. MASH is closely associated with the following cardiometabolic risk factors:
- Type 2 diabetes
- Obesity
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
Additionally, certain people may also be at higher risk for fatty liver disease, which can progress to MASH, like those of Hispanic or Asian descent with specific genetic factors.
Certain metabolic disorders, including fatty liver disease and MASH, are partially influenced by factors you can control, although it may be difficult, and ones you may not be able to control, including family history and certain health conditions.
MASH is closely associated with the following cardiometabolic risk factors:
- Type 2 diabetes
- Obesity
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
Learn more about how fatty liver disease progresses to MASH.
When addressed early, liver damage from MASH may be stopped or even reversed. Talk to your health care professional about MASH management, including potential lifestyle modifications or other therapies.
Learn more about how to create your own MASH management plan.
Over time, MASH can cause damage to the liver and potentially lead to other serious and life-threatening consequences. These include the risk of heart disease or liver cancer. It can also include the risk of cirrhosis that can lead to liver failure or the need for a liver transplant. The best ways to move towards avoiding these outcomes are to stick to your MASH management plan and follow up regularly with your health care professional, so they can continue to monitor your liver health.
Cirrhosis occurs when liver scarring becomes severe and prevents the liver from working normally. While it’s often associated with excessive drinking, people living with MASH can develop cirrhosis even in the absence of alcohol consumption. It is important to continue to follow up with your health care professional and track your liver health.
Getting screened for MASH
There are several noninvasive testing options available for MASH screening. These include blood tests, imaging tests, and/or a combination of blood tests and imaging tests. Your health care professional will determine what your first step should be.
Learn more about the MASH screening process and how to get started.
Talk to your health care professional about whether you should be screened for MASH as soon as you know you may be at risk. If you’re diagnosed with MASH and it is addressed in its early stages, you may be able to stop or even reverse damage to your liver.
Learn more about signs, symptoms, and risk factors for MASH.
You already do so much to support your overall health—don't stop short by leaving your liver health out of the picture. If you think you could be at risk for fatty liver disease or MASH, ask your health care professional about whether you should get screened.
For help starting this conversation, check out the Talk to Your Doctor guide.
If you’re already managing other health conditions, it’s understandable that the last thing you may want is to add another to the list. But it’s important to know how certain health conditions may increase your risk for MASH. MASH and conditions that affect your cardiometabolic health are closely linked. If you live with type 2 diabetes, obesity, high blood pressure, high triglycerides (a type of fat), or low HDL (good cholesterol), ask your health care professional about whether you should be screened for MASH during your next appointment.
Learn more about conditions that are considered risk factors for MASH.
If you have fatty liver disease, it may be time to check on your liver again. One out of 5 people with fatty liver disease and no liver scarring (fibrosis) who then developed liver scarring, progressed to advanced liver scarring in 6 years (in medical studies of 52 patients). Serious and potentially life-threatening consequences of MASH include the risk of heart disease or liver cancer. It can also include the risk of cirrhosis that can lead to liver failure or the need for a liver transplant. With regular testing, you and your health care professional can monitor your liver health and work to prevent future complications. The American Association for the Study of Liver Diseases recommends that, depending on risk factors, you may need to be reassessed every 1 to 3 years.
Learn more about signs, symptoms, and risk factors for MASH.
You can ask your primary care provider or a specialist (endocrinologist, gastroenterologist, hepatologist, cardiologist, etc) about your risk factors for MASH. If necessary, they can order some of the initial tests needed for screening.
Learn more about the MASH screening process and how to get started.
Living with and managing MASH
When MASH is addressed early, liver damage may be stopped or even reversed.
You can work with a nutritionist, or another health care professional (HCP), to create a MASH management plan designed to adapt to your evolving health needs over the course of your journey. This may include:
- Following a liver health–friendly diet (including low-sugar, low-fat, plant-based foods)
- Exercising regularly
- Losing weight
- Working with your HCP to address cardiometabolic risk factors
Learn more about how to create your own MASH management plan.
Weight loss is often recommended for people living with MASH. You may be able to improve fatty liver disease through exercise and a more active lifestyle. Talk to your health care professional about what kind of physical activities are right for you. If you’re having trouble losing weight on your own, talk to them about available resources or specialists who can help create a MASH management plan. Even small changes to your everyday activities can make a difference.
Learn more about MASH management and ways to boost your physical activity.
You can work with your health care professional to identify the lifestyle changes that are right for you. This may include a weight management plan. You can work together to determine what makes the most sense for your situation. But know that every little bit helps; losing just 3%-5% of your body weight can start to reduce the excess fat in your liver.
Learn more about setting meaningful and attainable goals to help manage MASH.
While MASH can develop even in the absence of alcohol consumption, most experts recommend that people living with MASH limit how much they drink. Consult with your health care professional for specific, individualized guidance on alcohol consumption.
For help starting a conversation, check out the Talk to Your Doctor guide.
MASH progression is measured primarily by monitoring the amount of fibrosis, or scarring, in the liver. When too much fat builds up in the liver, it can trigger inflammation. This may cause liver cells to become damaged or die, which may cause scarring. The buildup of scar tissue is known as fibrosis. Through regular follow-ups with your health care professional, you can monitor your level of fibrosis and discuss potential adjustments to your management plan.
While it may take years to advance from one stage of MASH to the next, some people may progress faster than others. In fact, 1 out of 5 people with fatty liver disease and no liver scarring (fibrosis) who then developed liver scarring, progressed to advanced liver scarring in 6 years (in medical studies of 52 patients). Getting screened for MASH gives you the best opportunity for early detection. Why does this matter? When MASH is addressed early, liver damage may be stopped or even reversed. Talk to your health care professional about routine monitoring to track your MASH progression.
Consider joining a MASH support group to meet people who can relate to what you’re going through. Listening to others talk about the struggles and triumphs they’ve experienced—and sharing your own—can provide additional help on your MASH journey.
For opportunities to connect with the MASH community, check out organizations like the American Liver Foundation, Community Liver Alliance, Fatty Liver Foundation, Global Liver Institute, MyMASHTeam, and NASH Knowledge.
NASH=nonalcoholic steatohepatitis.
Having support can help you navigate life with MASH, especially when it comes to the lifestyle changes you want to make.
Explore this discussion guide designed to help you navigate the conversation about MASH with your family and friends:
The information provided is for educational purposes only.
