MAFLD vs. MASH: What’s the Difference?

MALFD occurs when there’s a buildup of fat in the liver, and MASH is a later stage of MAFLD. Although MASH develops from MAFLD, the two conditions have several differences:

Severity

MAFLD: This type of liver disease causes fat to build up in the liver. The early stages of this condition are mild compared to the later stages.

MASH: This is a more severe stage of MAFLD symptoms, with increased fat buildup in the liver. Additional symptoms include inflammation (swelling) and liver damage.

Potential Complications

MAFLD: If left untreated, MAFLD can become more severe and turn into MASH. About 20-30% of cases of MAFLD turn into MASH, though the exact cause isn’t known.

MASH: Untreated MASH can cause fibrosis, which can progress into cirrhosis. Cirrhosis occurs when healthy liver tissues turn into scar tissue, preventing the liver from functioning properly.

As cirrhosis worsens, it can cause portal hypertension (high blood pressure that affects blood flow to abdominal organs), jaundice (yellowing of the skin and eyes), and hepatic encephalopathy (toxin buildup in the brain, causing confusion or difficulty thinking).

Untreated cirrhosis may eventually lead to liver failure or hepatocellular carcinoma (HCC), a type of liver cancer and the leading cause of liver transplants. MAFLD won’t turn into cirrhosis and liver failure unless it advances into MASH.

Different Treatment Options

MAFLD: No FDA-approved medications are currently available to treat MAFLD. Treatment options for MAFLD focus on lifestyle changes like maintaining the weight you and your healthcare provider discussed was optimal for you, exercising, avoiding alcohol, and eating a balanced diet.

MASH: The U.S. Food and Drug Administration (FDA) approved a drug, Rezdiffra (resmetirom), for treating MASH with moderate or severe fibrosis. Rezdiffra works by lowering the buildup of fat in the liver. Healthcare providers recommend taking this medication alongside a healthful diet and regular exercise to maximize its effectiveness and slow disease progression.

However, for MASH cases with significant cirrhosis, liver transplant surgery may be the only treatment option to restore liver function.

MAFLD and MASH share several similarities. Understanding these similarities can help in the early detection and prevention of disease progression.

Lifestyle Changes for Symptoms

Your healthcare provider may recommend lifestyle changes that can improve MAFLD and MASH.

Some strategies for relieving symptoms include:

• Maintain the weight discussed with your provider
• Eat a well-balanced diet
• Exercise regularly
• Limit sugar
• Avoid saturated fats found in meat, poultry skin, and certain milk and dairy products

Risk Factors

Since MASH is a more advanced stage of MAFLD, both conditions share common risk factors.

These risk factors include:

• Obesity
• High cholesterol (a fatty substance found in your liver and intestines)
• Type 2 diabetes
• Metabolic syndrome (traits and conditions linked to obesity)

Diagnostic Approaches

Healthcare providers may try to diagnose MAFLD and MASH similarly by reviewing your medical history and performing a physical exam to check for symptoms and diagnostic tests.

During your exam, your provider may ask you about:

• Your diet
• Medications you’re currently taking
• Other health conditions you have that may increase the risk of MAFLD or MASH

Some tests that can help diagnose both conditions include blood tests, such as liver function tests (to see how well your liver is working), and imaging tests like ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

You can’t have MAFLD and MASH at the same time since MASH is a more severe stage of MAFLD.

Healthcare providers diagnose MAFLD based on the buildup of fat in the liver. If left untreated, MAFLD can turn into MASH, causing additional symptoms like swelling and liver damage. Untreated MASH may progress into liver cirrhosis, which can also lead to liver failure.

If you start experiencing symptoms of MAFLD or MASH, you may want to contact a hepatologist (a doctor specializing in diagnosing and treating liver conditions).

Symptoms may include:

• Extreme fatigue
• Nausea
• Vomiting
• Abdominal pain
• Jaundice
• Easy bleeding or bruising

If you’ve already been diagnosed with a liver condition, you should follow up regularly with your hepatologist to monitor your condition. You should also reach out if symptoms don’t improve after treatment.

MAFLD and MASH are liver conditions that cause fat buildup in the liver. MASH most often progresses from MAFLD, causing inflammation and liver damage.

Both conditions have similar risk factors and diagnostic steps.

If you are experiencing symptoms of liver disease, a hepatologist can help diagnose your specific condition and recommend suitable treatment approaches.