What is steatotic liver disease?

Steatotic liver disease, more commonly known as hepatic steatosis or “fatty liver,” is a liver disease characterized by the accumulation of fat in liver cells. It is a complex health problem with a multifactorial pathophysiology involving genetic, endocrine, and metabolic factors.
This condition is often associated with metabolic disorders, such as obesity, type 2 diabetes, and dyslipidemia. Due to its relationship with these metabolic diseases, steatotic liver disease associated with metabolic dysfunction (MASLD) now represents one of the leading causes of chronic liver disease in the West.

The incidence of MASLD

The incidence of MASLD has increased significantly in recent decades, in parallel with the increasing prevalence of obesity and metabolic diseases. It is estimated that up to 25% of the world population may be affected by this disease. Industrialized countries, where high-sugar, high-fat diets and a sedentary lifestyle are common, are seeing a worrying increase in cases of MASLD.

Complications and evolution of MASLD

If this disease is not adequately detected and managed, it can progress to serious complications, such as steatohepatitis, cirrhosis, and liver cancer. Liver disease related to metabolic dysfunction progresses on a spectrum:

1. It begins with the accumulation of lipids in liver cells: fatty liver.
2. This can be followed by an inflammatory reaction that damages liver cells: steatohepatitis.
3. Progression can lead to liver fibrosis: At this stage, the risk of complications and major adverse liver effects is increased, namely liver cirrhosis, liver failure, and hepatocellular carcinoma.
   
   

What causes MASLD?

Several mechanisms are involved in the development and progression of the disease.
The two main risk factors are:

• Obesity, particularly visceral obesity
• Type 2 diabetes
  
  

The diagnosis

Most patients with MASLD are asymptomatic, making early diagnosis difficult. A clinical suspicion by the physician followed by targeted laboratory and imaging investigations can lead to diagnosis and appropriate management.

The treatments

Currently, there is no treatment available in Canada for MASLD. Management is mainly based on correcting risk factors and improving lifestyle habits.

• Weight loss is the cornerstone of treatment. It can reverse steatosis and even hepatic fibrosis.
• Limiting alcohol consumption is an important factor in avoiding further damage to the liver.
• Regular physical activity contributes to weight management and maintaining muscle mass.
  
  

How to prevent the steatotic liver disease?

Steatotic liver disease linked to metabolic diseases represents a real public health issue. Prevention and management of this condition mainly depends on the adoption of healthy lifestyles, with particular emphasis on reducing obesity and controlling metabolic comorbidities. Early diagnosis and appropriate management can prevent serious complications and improve quality of life.