If you are overseeing metabolic disease for your patients, it is likely that you are also encountering liver disease, regardless of your awareness. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition that impacts as many as 70% of people with type 2 diabetes or obesity. Nonetheless, routine screening for liver disease remains infrequent. This lack of attention is troubling, as the liver serves as a significant marker of metabolic dysfunction, providing opportunities for early intervention.
The belief among clinicians that fat in the liver is a benign issue is incorrect. The liver not only mirrors metabolic dysfunction but also worsens it. Liver fat is not merely a consequence of insulin resistance; it actively promotes it. This leads to a worsening cycle where insulin resistance leads to greater fat accumulation in the liver, which subsequently amplifies systemic inflammation and insulin resistance.
The potential for cirrhosis due to MASLD does exist but involves only 3-5% of patients. In contrast, the likelihood of cardiovascular disease and progression to diabetes is substantial in nearly all instances, with MASLD doubling the risk of a cardiovascular event. Early identification is vital, yet standard liver function tests such as ALT and AST are often unreliable for initial diagnosis. Up to 80% of patients with MASLD and 60% with metabolic dysfunction-associated steatohepatitis (MASH) may show “normal” ALT levels, leaving serious issues like fibrosis unnoticed until they reach advanced stages.
Non-invasive techniques like vibration-controlled transient elastography (VCTE) offer trustworthy assessments of liver fat and fibrosis and are crucial for early identification and management. Sharing with patients their steatosis and fibrosis scores can lead to a significant impact, making discussions about lifestyle modifications and treatment strategies more concrete and practical.
Regularly monitoring liver health should be a standard practice, similar to managing any chronic illness, to enhance the patient-doctor relationship and customize treatment plans based on solid data. The challenge of addressing steatotic liver disease goes beyond just weight management; it requires comprehending the roles of genetics, biology, and other factors. Even seemingly healthy individuals, such as athletes, can develop MASLD.
Acknowledging the liver’s role in metabolic disease is merely the starting point; implementing regular practices to identify, measure, and monitor liver health is crucial for enhancing patient outcomes. By adopting these strategies, both providers and patients can more effectively manage metabolic health, resulting in better overall well-being.
_Martin Grajower is an endocrinologist._