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Metabolic fatty liver disease (MASLD)

Steatosis hepatis metabolica · Metabolická steatóza jater (MASLD)

What it is

Fat accumulates in liver cells; up to 30% of adults, and it can progress to cirrhosis.

Symptoms & signs

  • Usually silent
  • fatigue
  • dull right upper ache
  • found on scan or raised liver enzymes

🚩 Get help if…

  • call 112 / 911 now Vomiting blood or black tarry stools
  • call 112 / 911 now Confusion or unusual sleepiness
  • see a doctor soon Yellow skin or eyes
  • see a doctor soon Swelling of the belly or legs

Where it strikes

Medical treatment

  • Resmetirom (first approved drug; steatohepatitis resolved in about 26–30% vs 10% on placebo at a year)
  • GLP-1 agonists
  • treat diabetes and lipids
  • vitamin E in selected non-diabetics
  • bariatric surgery

Natural & lifestyle

  • 7–10% weight loss reverses steatohepatitis
  • Mediterranean diet
  • cut fructose and alcohol
  • coffee 2–3 cups/day (protective)
  • resistance and aerobic exercise

Emerging & experimental

  • FGF21 analogues (efruxifermin)
  • pan-PPAR agonists
  • combination GLP-1/GIP therapy

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Silymarin (milk thistle) — trials show modest improvements in enzymes and fibrosis; results mixed mixed evidence
  • Intermittent fasting and time-restricted eating — trials show liver-fat loss similar to calorie restriction mixed evidence
  • Omega-3 — lowers liver fat modestly, not inflammation mixed evidence
  • Berberine — small trials lower liver fat early / small studies
  • 'Liver detox' teas and cleanses — no evidence; some have caused liver injury anecdotal / traditional

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