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 indicate 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.
It's important to remember that you could still have fatty liver disease or MASH even if liver enzymes are not elevated.
Learn more about how AST and ALT are used in the MASH screening process.
Your liver doesn't always let you know when something is wrong, like some organs do. Symptoms of fatty liver disease or MASH can sometimes be hard to detect. In fact, some people with MASH do not experience symptoms before they are diagnosed. People who reported symptoms prior to receiving a diagnosis of MASH experienced fatigue, nausea, loss of appetite, abdominal pain, or 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 (HCP) about whether you should be screened for MASH. These are some health conditions that are associated with MASH:
- Fatty liver (or family history of cirrhosis)
- Type 2 diabetes or prediabetes
- Obesity
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
- Persistently elevated liver enzymes (over 6 months)
- PMOS (polyendocrine metabolic ovarian syndrome)*
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. If you are living with any of these health conditions, ask your HCP whether you should be screened for MASH.
*PMOS was formerly known as PCOS (polycystic ovary syndrome).
HDL, high-density lipoprotein.
MASH is caused by metabolic dysfunction, a term used to describe how nutrients, such as fats and carbohydrates, are processed and distributed differently than they should be throughout the body. MASH is influenced by factors you cannot control (such as family history) and factors that may be difficult to control (such as diet, activity levels, and certain health conditions).
If you are living with any of these health conditions, ask your health care professional whether you should be screened for MASH.
- Fatty liver (or family history of cirrhosis)
- Type 2 diabetes or prediabetes
- Obesity
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
- Persistently elevated liver enzymes (over 6 months)
- PMOS (polyendocrine metabolic ovarian syndrome)*
*PMOS was formerly known as PCOS (polycystic ovary syndrome).
HDL, high-density lipoprotein.
When addressed early, liver damage from MASH may be stopped or even reversed. Talk to your health care professional about a long-term plan for 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 may lead to life-threatening consequences like heart attack, heart failure, stroke, liver cancer, or cirrhosis that can lead to liver failure or the need for a liver transplant. In fact, if not treated, MASH can shorten a person's life span. The best ways to move toward 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 can be 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
Talk to your health care professional about getting screened for MASH. Screening often starts with a FIB-4 score, a simple calculation that helps assess your risk for advanced liver scarring, also known as fibrosis. If needed, a second step is taking a more specific type of noninvasive test to further assess your risk.
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 have one or more risk factors for MASH. 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 metabolic and heart health are closely linked. At your next appointment, ask your health care professional if you should be screened for MASH if you have any of the following:
- Fatty liver (or family history of cirrhosis)
- Type 2 diabetes or prediabetes
- Obesity
- High blood pressure
- High triglycerides (a type of fat)
- Low HDL (good cholesterol)
- Persistently elevated liver enzymes (over 6 months)
- PMOS (polyendocrine metabolic ovarian syndrome)*
*PMOS was formerly known as PCOS (polycystic ovary syndrome).
HDL, high-density lipoprotein.
If you have fatty liver disease, it may be time to check on your liver again. The speed of worsening varies, but some people have rapidly progressed from no scarring to advanced fibrosis in ~6 years.* Over time, MASH can cause damage to the liver and may lead to life-threatening consequences like heart attack, heart failure, stroke, liver cancer, or cirrhosis that can lead to liver failure or the need for a liver transplant. In fact, if not treated, MASH can shorten a person's life span. 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.
*Combined data from 52 patients from multiple studies.
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.
Your FIB-4 (Fibrosis-4) score can give you and your health care professional (HCP) more insight into whether you should be tested for MASH and liver scarring. It's a calculation used to assess your likelihood of advanced liver scarring. While not intended to diagnose MASH, a FIB-4 score can provide you with valuable information. Be sure to ask your HCP to calculate yours if you think you're at risk for MASH and liver scarring.
Learn more about how a FIB-4 score is calculated and what the result means.
Living with and managing MASH
When MASH is addressed early, liver damage may be stopped or even reversed.
Work with your health care professional (HCP) to develop a personalized MASH management plan that can adapt as your health needs change over time. You may also benefit from consulting a nutritionist to help support your plan with expert dietary guidance. Key components of your plan may include:
- Following a liver health–friendly diet (including low-sugar, low-fat, plant-based foods)
- Exercising regularly
- Working with your HCP to address risk factors
- Medication
Learn more about how to create your own MASH management plan.
Health care professionals often recommend weight loss in people with MASH because clinical data suggest it can help improve or even reverse MASH. But know that you are not alone. Losing weight and keeping it off can be difficult for many people with MASH. While losing 10% or more of body weight was shown to resolve MASH in almost all patients, in a clinical study, only 10% of people were able to achieve this amount of weight loss after a year of structured diet and lifestyle interventions alone.
If you’re struggling to lose weight with MASH, talk to your health care professional about your treatment options. Medication, along with diet and exercise, may be a part of your MASH management plan.
Learn more about MASH management and ways to boost your physical activity.
You can work with your health care professional (HCP) to identify the lifestyle changes that are right for you. This may include a weight management plan, but you can work with your HCP 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.
Get tips for discussing your MASH management plan with your doctor.
While it may take years to advance from one stage of MASH to the next, some people may progress faster than others. In fact, some people have experienced rapid progression from no scarring (stage 0) to advanced scarring (stage 3 or 4) in ~6 years.* Talk to your health care professional about how your MASH is progressing and what steps you can take to manage it.
*Combined data from 52 patients from multiple studies.
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, Fatty Liver Alliance, Global Liver Institute, and Liver Education Advocates.
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:
MASH-FRIENDLY EATING
Certain words on menus can tip you off to healthier options. Look out for:
Cooking styles: grilled, sautéed, roasted, steamed, baked, poached—these are usually healthier and lower in calories than fried or battered.
Descriptive words: healthy, light, fresh, fit, vegetarian, skinny—these often mean the meal has healthier substitutions built in.
Ingredients: whole grains—request whole-grain bread and pasta or brown rice instead of white versions.
It might feel difficult to eat healthier foods, especially if you aren't cooking at home. Here are a few tips:
Check the menu ahead of time. Many restaurants share nutrition info online, so you can plan before you order.
Don't be afraid to ask. Request substitutions or ask how a dish is prepared—most places are happy to adjust.
Watch portions. Restaurant meals may be oversized. Share with a friend or save half for later.
Customize your plate. Ask for sauces and dressings on the side so you can control how much you use.
Add color. Look for meals with plenty of veggies and fresh ingredients—a colorful plate may mean more nutrients.
Avoid shopping when you're hungry. This can lead to impulse or craving purchases.
Plan meals ahead of time. This can help to avoid buying items you may already have.
Try online grocery shopping. This can help to limit extra or unhealthy items while in the store. (You can use those coupons online too!)
Healthy eating doesn’t mean giving up everything you love. It's about making changes that can add up over time.
No one is perfect when it comes to diet! Remember, getting back on track is the most important part. Try picking one food to include or exclude on a daily or weekly basis to start. Each healthy choice can add up and help you manage MASH.
The information provided is for educational purposes only.
