Hidden in Plain Sight: Recognizing MASH, a Silent Disease

There’s a reason metabolic dysfunction–associated steatohepatitis (MASH) — an advanced form of fatty liver disease that’s not related to alcohol consumption — is referred to as a “silent disease.”

“I see a lot of people who might have been told that they had fatty liver decades ago but were told not to worry about it, and now they’re coming in with cirrhosis,” says Kara Wegermann, MD, a gastroenterologist and transplant hepatologist at Duke Health in Durham, North Carolina, and a volunteer for the American Liver Foundation. “[Some] people are not aware of the disease progression.”

If you’ve been diagnosed with MASH, or have risk factors for it, here’s what you can do to protect your liver and overall health.

I had no symptoms. I didn’t know there was anything wrong. … I’ve always gone to my primary doctor on a regular basis … and that’s when I was diagnosed with MASH.

— Jeff Beckley, diagnosed with MASH in 2024

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Having certain health conditions, such as obesity, type 2 diabetes, high cholesterol, or metabolic syndrome, can increase your risk of developing MASH. But unlike, say, screening for high blood pressure, there’s no straightforward way to screen for MASH. This is part of the reason people may be living with MASH — or experiencing MASH progression — and not know it.

“We don’t currently have a screening protocol for the general population, so it’s sort of up to your primary care doctor to do additional tests if they see elevated liver enzymes,” says Dr. Wegermann. If you have other health conditions that increase your risk of MASH, your doctor may decide to monitor your liver health with tests, such as a liver ultrasound or fatty liver index lab values, she adds.

• Pain or achiness in your upper right abdomen
• Fatigue or weakness
• Loss of appetite
• Unexplained weight loss

The damage that was detected at my initial diagnosis didn’t happen overnight. It was probably done decades before, and it was going to continue to cause destruction to my liver cells if I didn’t make changes to stop it.

— Susan Avallone, diagnosed with MASH in 2003

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MASH is a progressive disease, but one that tends to advance slowly. Moreover, not everyone’s condition progresses in quite the same way. “Some people have fat in their liver and never seem to get inflammation, scarring, or fibrosis,” says Wegermann. “Other people have a lot of inflammation and progress more quickly.”

• Eating a healthy diet
• Exercising regularly
• Losing weight if needed
• Quitting smoking
• Limiting or cutting out alcohol
• Prioritizing quality sleep

It’s also important to treat any other health conditions you have. “Managing blood sugar, weight, and blood pressure are also all really important for long-term health,” says Wegermann.

The most important thing you can do to protect your liver health is schedule regular checkups with your primary care provider. “If your primary care doctor is checking routine blood work, they’ll have a chance to see if [there are abnormalities] in the liver and if there’s any further testing that needs to be done,” says Wegermann.

If MASH is detected early enough, you may also be a candidate for further treatment, which can help prevent the progression of the disease and future problems with the liver, says Wegermann. “You have an opportunity to intervene and stay healthy longer,” she says.