Since screening is not routine and the disease process may be mostly asymptomatic, many patients are unaware of the earlier, underlying condition of steatosis. These patients may only learn of it after their disease has advanced to a more severe form. Historically, even in cases when fat in the liver had been spotted through ultrasounds or other scans, the findings have often been considered incidental or of limited clinical significance. 1 “We’ve now learned that what used to be called ‘fatty liver’ or ‘benign steatosis’ is, in fact, not a harmless condition,” says Scott Isaacs, MD, an endocrinologist at Emory University School of Medicine in Georgia and co-author of a 2025 consensus report on the topic for the American Diabetes Association (ADA). “Many of us in endocrinology have cared for patients who were told for years that ‘a little fatty liver’ or mildly abnormal liver enzymes were nothing to worry about until these patients were suddenly presenting with signs of advanced liver disease.” Because liver screenings are not always routine and steatotic liver disease is often asymptomatic, it’s not uncommon for the diagnosis to occur outside the initial point of care. “Many in endocrinology would say, ‘I see plenty of people with type 2 diabetes, but they never complain of a liver problem’ or ‘I’ve never seen anybody with cirrhosis in my clinic,’”
not usually the cause of death. Most people with chronic kidney or liver disease ultimately die from cardiovascular causes, explains Cusi, adding: “The liver disease may never have been diagnosed, despite being present.” All metabolic abnormalities contribute to the overall dysfunction. “Chronic kidney and liver disease promote cardiovascular disease,” says Cusi, “so identifying them and treating them will likely have a positive impact on cardiovascular disease as well.” Evolution of Nomenclature & Staging Research has deepened understanding of the varied pathology of liver disease, clarifying terminology that better describes its etiology and stages. Importantly, advances in disease biology have revealed that steatotic liver disease is about more than just the liver: It’s now understood to reflect systemic metabolic dysfunction that drives progressive liver injury. “When you’re in a state of metabolic unhealthiness, the inflammation and damage that occurs from it are in tissues everywhere,” says Cusi, “from the endothelial layers of your blood vessels to the glomeruli of your kidneys to your liver cells.” nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) is now named according to what causes it, rather than what doesn’t (alcohol). In 2023, a multi-organization Delphi What was first known as fatty liver, then coined
explains Kenneth Cusi, MD, FACP, FACE, Chief of the Division of Endocrinology, Diabetes & Metabolism in the Department of Medicine at the University of Florida, in Gainesville, and the lead author of the 2025 ADA consensus report. “But typically, MASLD is asymptomatic—until it’s not. By the time someone gets really sick from liver disease, it happens suddenly.” Care often transitions across specialties as disease progresses, which can limit continuity of care. Another reason for the underdetection of liver disease is that, even though it can be deadly, it is
process dubbed it metabolic-dysfunction-associated steatotic liver disease (MASLD) and, in its more advanced stages, metabolic-dysfunction-associated steatohepatitis (MASH). MetALD is the term now used for patients with MASLD who consume moderate to large amounts of alcohol. 2 The Pathogenesis of MASLD & MASH Because the disease develops over time and there is a known pathway to severe progression, when identified early, MASH may be treatable and, in some cases,
4 Healthful Living Rx
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