girl holding the right side of her abdomen at the liver in pain

What is Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)? Causes and Symptoms


Written by: CDHF

Updated: January 29th, 2024

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 transplantation. For the purpose of this article, we will be referring to this condition as MASLD.  

What is MASLD?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a medical condition characterized by the accumulation of fat in the liver of individuals who consume little to no alcohol or do not have a history of excessive alcohol consumption. It is one of the most common liver disorders in the world and is often associated with obesity, insulin resistance, and metabolic syndrome.  MASLD exists on a spectrum that encompasses simple fat deposition in the liver, liver plus fat inflammation and/or scarring or cell damage, and ultimately liver cirrhosis in its most advanced form.

stages of liver damage including MASLD - fatty liver disease

Causes and Risk Factors

MASLD is primarily driven by lifestyle factors and metabolic conditions. Some of the key causes and contributing factors to MASLD include:


MASLD is often considered a “silent” liver disease because many individuals with MASLD do not experience noticeable symptoms, especially in the early stages of the condition. Symptoms tend to become more evident as MASLD progresses to more advanced stages or develops into metabolic dysfunction-associated steatohepatitis (MASH), which is characterized by liver inflammation and damage. Common symptoms and signs of MASLD and MASH include:

  1. Fatigue: People with MASLD or MASH may often feel unusually tired or fatigued, even after getting adequate sleep.
  2. Right Upper Abdominal Discomfort: Some individuals may experience discomfort or a dull ache in the upper right side of the abdomen, where the liver is located. This discomfort is typically mild and may come and go.
  3. Unexplained Weight Loss or Poor Appetite: In more advanced cases of MASLD or MASH individuals may unintentionally lose weight or have a decreased appetite.

If cirrhosis, (the most advanced stage) occurs, more pronounced symptoms may manifest, including jaundice characterized by yellowing of the skin and the whites of the eyes, itchy skin, and swelling in the legs, ankles, feet, or abdomen (edema).

As MASLD is often asymptomatic in its early stages, it is often discovered incidentally during medical tests or check-ups. Routine screening for MASLD is not typically performed unless risk factors are present, such as obesity, diabetes, or abnormal liver function test results. If you suspect you may have MASLD or are experiencing concerning symptoms related to your liver or overall health, it is essential to seek medical evaluation and guidance from a healthcare provider.

Early detection and management can help prevent the progression of MASLD to more severe liver conditions. 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, which we talk about in this article. This helps determine the level of fibrosis or scarring. If diagnosed with advanced fibrosis, referral to a liver specialist or hepatologist is recommended.


  1. Rinella, Mary E.1; Lazarus, Jeffrey V.2,3; Ratziu, Vlad4; Francque, Sven M.5,6; Sanyal, Arun J.7; Kanwal, Fasiha8,9; Romero, Diana2; Abdelmalek, Manal F.10; Anstee, Quentin M.11,12; Arab, Juan Pablo13,14,15; Arrese, Marco15,16; Bataller, Ramon17; Beuers, Ulrich18; Boursier, Jerome19; Bugianesi, Elisabetta20; Byrne, Christopher D.21,22; Castro Narro, Graciela E.16,23,24; Chowdhury, Abhijit25,26; Cortez-Pinto, Helena27; Cryer, Donna R.28; Cusi, Kenneth29; El-Kassas, Mohamed30; Klein, Samuel31; Eskridge, Wayne32; Fan, Jiangao33; Gawrieh, Samer34; Guy, Cynthia D.35; Harrison, Stephen A.36; Kim, Seung Up37; Koot, Bart G.38; Korenjak, Marko39; Kowdley, Kris V.40; Lacaille, Florence41; Loomba, Rohit42; Mitchell-Thain, Robert43; Morgan, Timothy R.44,45; Powell, Elisabeth E.46,47,48; Roden, Michael49,50,51; Romero-Gómez, Manuel52; Silva, Marcelo53; Singh, Shivaram Prasad54; Sookoian, Silvia C.15,55,56; Spearman, C. Wendy57; Tiniakos, Dina11,58; Valenti, Luca59,60; Vos, Miriam B.61; Wong, Vincent Wai-Sun62; Xanthakos, Stavra63; Yilmaz, Yusuf64; Younossi, Zobair65,66,67; Hobbs, Ansley2; Villota-Rivas, Marcela68; Newsome, Philip N69,70;  on behalf of the NAFLD Nomenclature consensus group. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology ():10.1097/HEP.0000000000000520, June 24, 2023. | DOI: 10.1097/HEP.0000000000000520
  2. Canadian Liver Foundation
  3. Prince SA, Melvin A, Roberts KC, et al. Sedentary behaviour surveillance in Canada: trends, challenges and lessons learned. International Journal of Behavioral Nutrition and Physical Activity. 2020; 17: 34.

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