Metabolic-Associated Steatotic Liver Disease (MASLD — the new 2023 name for NAFLD) is the accumulation of fat in the liver in people with metabolic risk factors (overweight/obesity, type 2 diabetes, dyslipidaemia, hypertension) — without significant alcohol consumption. It is the hepatic manifestation of metabolic syndrome and affects approximately 1.5 billion people globally (25-38% of adults). Most people with MASLD have "simple steatosis" (fat accumulation without significant inflammation) and low risk of progression; 20-30% have the more serious MASH.

What is the difference between MASLD and MASH?

MASLD (simple steatosis) is fat accumulation in the liver without significant inflammation — generally a benign condition with low progression risk. MASH (Metabolic-Associated Steatohepatitis) is the aggressive form, characterised by steatosis plus active inflammation plus hepatocyte injury (ballooning). MASH can progress to liver fibrosis, cirrhosis and hepatocellular carcinoma. Approximately 20-30% of MASLD patients have MASH; of those with MASH, approximately 20% develop cirrhosis within 20 years.

MASLD is driven by: obesity (excess adipose tissue releases fatty acids to the liver); type 2 diabetes and insulin resistance (excess glucose converted to hepatic fat); dyslipidaemia; sedentary lifestyle; and genetic predisposition (PNPLA3 I148M variant greatly increases risk). Dietary factors — high fructose (from sugar-sweetened beverages), high saturated fat, processed foods — directly fuel hepatic fat accumulation. The global obesity and diabetes epidemics are the primary drivers of rising MASLD burden.

How is MASLD diagnosed?

Most MASLD is detected incidentally on liver ultrasound or by elevated liver enzymes (ALT/AST) on routine blood tests. Liver ultrasound is used for diagnosis of steatosis. Non-invasive fibrosis assessment uses: FIB-4 index (calculated from age, ALT, AST, platelet count — validated for MASLD staging); transient elastography (FibroScan); and MR elastography. Liver biopsy remains the gold standard for staging but is invasive — reserved for uncertain cases or clinical trials.

What is the new MASH treatment?

Resmetirom (Rezdiffra) — a selective thyroid hormone receptor beta (THR-β) agonist — became the first FDA-approved pharmacological treatment specifically for MASH with liver fibrosis in March 2024. In the MAESTRO-NASH pivotal trial, resmetirom achieved MASH resolution or fibrosis improvement (the two FDA co-primary endpoints) in a significantly higher proportion of patients than placebo. Multiple other agents are in Phase 3 trials (semaglutide, lanifibranor, obeticholic acid).

Can MASLD be reversed?

Yes — early MASLD (simple steatosis, mild fibrosis) can be reversed with lifestyle change. Weight loss of 5-10% reduces hepatic steatosis significantly; 10-15% weight loss can achieve MASH remission. Sustained >10% weight loss can regress liver fibrosis. Bariatric surgery achieves MASH resolution in approximately 85% of patients and fibrosis regression in approximately 70%. GLP-1 receptor agonists (semaglutide) show preliminary evidence of MASH improvement alongside weight loss.

How does MASLD relate to liver cancer?

MASLD is an independent risk factor for hepatocellular carcinoma (HCC) — even in the absence of cirrhosis (though cirrhosis dramatically amplifies risk). MASLD-related HCC now accounts for approximately 15-30% of HCC in high-income countries and is the fastest-growing aetiology. The mechanism involves chronic inflammation, oxidative stress, insulin resistance signalling and fatty acid accumulation promoting hepatocyte transformation. Annual liver ultrasound surveillance for HCC is recommended in MASLD cirrhosis.

What is the link between alcohol and fatty liver?

Alcoholic fatty liver disease (ALD) and MASLD (metabolic fatty liver) share a spectrum of overlapping histological findings — steatosis, steatohepatitis, fibrosis — but differ in aetiology. MASLD is defined by metabolic risk factors with minimal alcohol intake. ALD is driven by alcohol consumption. Some patients have metabolic alcohol-associated liver disease (MetALD) — both metabolic and alcohol drivers. The 2023 nomenclature change from NAFLD to MASLD was partly designed to clarify these distinctions and reduce stigma.

Cirrhosis is end-stage liver disease — diffuse scarring replacing functional liver tissue. In MASLD/MASH, cirrhosis develops after years to decades of progressive fibrosis. Cirrhosis causes portal hypertension (oesophageal varices, ascites, hepatic encephalopathy), hepatorenal syndrome and high liver cancer risk. Child-Pugh and MELD scores assess cirrhosis severity. Liver transplantation is the only curative treatment for decompensated cirrhosis. MASLD-related cirrhosis is now a leading indication for liver transplantation in high-income countries.

What lifestyle changes help MASLD?

Evidence-based lifestyle interventions: weight loss (5-10% for steatosis reduction; 10-15%+ for MASH resolution); Mediterranean dietary pattern (reduces hepatic fat independent of weight loss); aerobic exercise (150+ minutes/week); resistance training; elimination of sugar-sweetened beverages (fructose is directly lipogenic); and avoidance of ultra-processed foods. Alcohol limitation is particularly important in MASLD due to synergistic liver damage. Coffee consumption (3-4 cups/day) is associated with lower fibrosis risk in MASLD.

How does MASLD relate to cardiovascular disease?

MASLD is a marker and driver of cardiovascular risk: people with MASLD have a 2-fold higher risk of major cardiovascular events independent of traditional risk factors. The most common cause of death in MASLD patients (without advanced fibrosis) is cardiovascular disease, not liver-related mortality. This makes cardiovascular risk management — blood pressure, cholesterol, diabetes, weight — central to MASLD care.

How does GMJ News cover liver disease?

GMJ News tracks MASLD/MASH epidemiology, the resmetirom approval and pipeline agents, non-invasive fibrosis testing advances, MASLD-HCC links, and the obesity-liver disease nexus. MASLD is increasingly prevalent in Georgia alongside rising obesity and diabetes rates — a direct public health priority for PHIG and the Georgian Medical Journal.

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Liver Disease

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Non-alcoholic fatty liver disease — now renamed Metabolic-Associated Steatotic Liver Disease (MASLD) — affects an estimated 1.5 billion people globally (25-38% of adults) and has emerged as the fastest-growing cause of liver cirrhosis and liver cancer worldwide, driven by the twin epidemics of obesity and type 2 diabetes (WHO). The more severe form — Metabolic-Associated Steatohepatitis (MASH) — causes progressive liver scarring, cirrhosis and hepatocellular carcinoma in millions who have never consumed significant alcohol. The first approved MASH-specific treatment (resmetirom/Rezdiffra, FDA approved March 2024) marks the beginning of a new pharmacological era.

Key messages

1.5 billion with fatty liver

Metabolic-Associated Steatotic Liver Disease (MASLD) — formerly NAFLD — affects approximately 1.5 billion people globally (25-38% of the adult population) and has become the fastest-growing cause of liver cirrhosis and liver cancer worldwide.

Driven by obesity and diabetes

MASLD is the hepatic manifestation of metabolic syndrome — driven by obesity, type 2 diabetes, dyslipidaemia and sedentary lifestyle. As the global obesity epidemic grows, MASLD burden is projected to increase dramatically.

MASH — the dangerous form

Metabolic-Associated Steatohepatitis (MASH) — the severe form with active inflammation and fibrosis — affects approximately 5% of the global population (250 million people) and is the form that progresses to cirrhosis and hepatocellular carcinoma.

First approved treatment (2024)

Resmetirom (Rezdiffra) became the first FDA-approved pharmacological treatment specifically for MASH with fibrosis — approved March 2024. It represents the beginning of a new pharmacological era for a condition previously managed only with lifestyle modification.

Liver cancer link

Viral hepatitis (HBV and HCV) caused approximately 80% of hepatocellular carcinoma (HCC) historically. With HBV vaccination and HCV DAA treatment improving, MASLD-related HCC is now the fastest-growing HCC aetiology in high-income countries.

Silent disease

MASLD/MASH is asymptomatic until advanced cirrhosis — most patients are unaware of their diagnosis. Incidental detection by elevated liver enzymes (ALT, AST), liver ultrasound or abdominal imaging is the typical pathway.

Key statistics

1.5B

people with MASLD globally

Lancet 2022/WHO

25-38%

of adults globally have MASLD

Lancet 2022

250M

people with MASH (severe form)

WHO/EASL

liver disease deaths/year total (all causes)

WHO/GBD

2024

year of first MASH-specific drug approval (resmetirom)

FDA

830K

liver cancer deaths/year (HCC primarily)

IARC 2020

Global MASLD (fatty liver disease) prevalence by region (%) — Lancet Gastroenterology 2022

Source: Prevalence of metabolic-associated steatotic liver disease by region. Middle East highest; Africa increasing.

Glossary of key terms

MASLD
AASLD/EASL 2023Metabolic-Associated Steatotic Liver Disease — the new (2023) nomenclature replacing NAFLD (non-alcoholic fatty liver disease). Defined as hepatic steatosis with at least one of: overweight/obesity; type 2 diabetes; metabolic dysregulation (dyslipidaemia, hypertension). More aetiologically accurate than the exclusion-based NAFLD term.

MASH
AASLD/EASL 2023Metabolic-Associated Steatohepatitis — the severe form of MASLD, with steatosis plus hepatic inflammation plus hepatocyte ballooning (cell injury). Formerly called NASH (non-alcoholic steatohepatitis). The form that progresses to fibrosis, cirrhosis and hepatocellular carcinoma.

Liver fibrosis staging
METAVIR/IshakThe degree of liver scarring — staged F0 (no fibrosis) to F4 (cirrhosis). Advanced fibrosis (F3-F4) marks the threshold beyond which MASLD carries substantial risk of liver failure and cancer. Non-invasive tests (FIB-4 index, FibroScan/transient elastography) are increasingly replacing liver biopsy.

Transient elastography
EASL/AASLDA non-invasive liver stiffness measurement (FibroScan) assessing liver fibrosis by measuring speed of ultrasound wave propagation. The most widely used non-invasive liver fibrosis assessment tool. Also measures controlled attenuation parameter (CAP) for steatosis.

Resmetirom (Rezdiffra)
FDA 2024The first FDA-approved pharmacological treatment for MASH with fibrosis — a selective thyroid hormone receptor beta agonist reducing hepatic lipogenesis and inflammation. Approved March 2024 following the MAESTRO-NASH trial showing significant fibrosis improvement.

Hepatocellular carcinoma (HCC)
WHO/EASLPrimary liver cancer — the most common type of liver cancer globally, accounting for 75-85% of liver cancers. HBV and HCV have historically caused most HCC; MASLD-related HCC is now the fastest-growing aetiology in high-income countries.