Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) – Testing, Managing, and Prevention
Written by: CDHF
Updated: August 25th, 2025
MASLD is a prevalent liver condition that can range from simple fat accumulation in the liver (steatosis) to more severe inflammation and fibrosis. Preventing and managing MASLD involves a comprehensive approach that includes testing, and lifestyle modification. We go over all of this in this article.
In 2023, experts in liver disease came to a decision to rename non-alcoholic fatty liver disease (NALFD) to metabolic dysfunction-associated steatotic liver disease (MASLD). 1 MASLD is the most common cause of liver disease in North America and is soon to become to leading cause for liver transportation. For the purpose of this article, we will be referring to this condition as MASLD.
First up, how do we test for MASLD?
Diagnosing MASLD early is critical as the condition is reversible with lifestyle interventions. Once MASLD is suspected, determining the severity of the disease is an important next step. This can be achieved through bloodwork and scoring systems and/or specialized imaging such as an ultrasound or MRI. This helps determine the level of fibrosis or scarring. If diagnosed with advanced fibrosis, referral to a liver specialist or hepatologist is recommended. The choice of tests may vary depending on the patient’s risk factors, symptoms, and the healthcare provider’s clinical judgment. Below are the primary methods used to diagnose and assess MASLD.
Clinical Assessment
A healthcare provider will conduct a thorough medical history and physical examination. They will inquire about risk factors, such as obesity, diabetes, and family history of liver disease, and ask about any symptoms or concerns.
Blood Tests
- Liver Function Tests: Blood tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are used to assess liver function. Elevated liver enzymes may indicate liver inflammation or damage.
- FIB-4 is a non-invasive blood test that is calculated based on routine blood tests that measure specific liver enzymes and other parameters. Non-invasive risk scores like FIB-4 offer a safer alternative by utilizing easily accessible clinical parameters, including age, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, and platelet count. These scores provide clinicians with a reliable and efficient means of gauging the degree of liver fibrosis, helping to guide treatment decisions and monitor disease progression without subjecting patients to invasive procedures. As a result, non-invasive risk scores contribute significantly to the early detection and management of MASLD, enhancing patient care and reducing the need for more invasive diagnostic approaches.
- Complete Blood Count (CBC): Anemia or low platelet count can be associated with more advanced liver disease.
- Lipid Profile: Assessing lipid levels (cholesterol and triglycerides) can provide additional information about metabolic health.
- Blood Glucose Levels: Elevated blood glucose levels may suggest insulin resistance, a common risk factor for MASLD.
- Liver Fat Biomarkers: Specialized blood tests, such as the Fatty Liver Index, can estimate the amount of fat in the liver.
Imaging Studies
- Ultrasound: Ultrasonography is often the initial imaging test used for MASLD. It can detect the presence of fat in the liver and assess liver size and echogenicity (brightness).
- Magnetic Resonance Imaging (MRI): MRI can provide more detailed information about liver fat content and the presence of inflammation or fibrosis.
- Computed Tomography (CT) Scan: CT scans can also be used to assess liver fat and detect other liver abnormalities.
- Transient Elastography (FibroScan): This specialized ultrasound-based test measures liver stiffness, which can indicate the presence of fibrosis.
Liver Biopsy (In some cases)
- A liver biopsy is considered the gold standard for diagnosing and staging MASLD. It involves the removal of a small tissue sample from the liver, which is then examined under a microscope. This procedure is typically reserved for cases where the diagnosis is uncertain or advanced liver disease is suspected.
Managing and Preventing MASLD
Managing MASLD primarily focuses on lifestyle changes, as there is no specific medication that can cure the condition. The most effective treatment is gradual and sustainable weight loss through a healthy diet and physical activity. The goals of management are to reduce liver fat, prevent inflammation and fibrosis, and address underlying risk factors. Here are key strategies for managing MASLD:
- Adopt a Well-Balanced Diet:
- Eat a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats (olive oil, nuts, seeds, fish), foods rich in antioxidants (berries, beans and lentils, and leafy green vegetables)
- Limit the consumption of simple carbohydrates, sugary beverages, especially those that contain fructose, ultra-processed foods, and saturated fats
- The World Health Organization (WHO) recommends adults and children reduce their daily intake of added sugars to less than 10% of their total energy intake.
- For liver-friendly recipes visit Liver Foundation Canada.
- Portion Control: Monitor portion sizes to avoid excessive calorie intake, which can contribute to weight gain.
- Increasing Physical Activity: Engage in regular exercise and physical activity. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities on two or more days a week.
- Gradual Weight Loss: If overweight or obese, aim for gradual, sustainable weight loss. Even a modest weight loss of 5-10% of body weight can improve liver health.
- Avoid Crash Diets: Avoid extreme or crash diets, as rapid weight loss can worsen liver inflammation.
- Limit Alcohol Consumption: If you choose to drink alcohol, do so in moderation (less than two drinks per day for men, and 1 drink per day for women). Excessive alcohol consumption can harm the liver.
Monitoring and Follow-Up:
- Regularly schedule follow-up appointments with a healthcare provider to monitor liver health and assess progress.
- Track changes in liver enzymes and other relevant blood markers.
Remember that MASLD is a chronic condition (life-long), and managing it requires long-term commitment to a healthy lifestyle. Whether you are preventing or managing MASLD, working closely with healthcare professionals, including hepatologists, registered dietitians, and exercise specialists, can help create an effective plan tailored to your individual needs. Early intervention and sustained lifestyle changes are essential to prevent the progression of MASLD to more severe liver conditions.
This article was made possible due to an unrestricted educational grant from Novo Nordisk.
References
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