If you’re like most people, you get a diagnosis and then go google it. If you google NASH or NALFD or fatty liver, you will get a lot of terms. However the terms are changing. No matter what you call it, you wonder about treatment options and how it will progress. When you bump into new words and terms you might get confused. So if you’re wondering MASLD vs MASH: Where are you on the spectrum? I’ll put it in plain patient language.
MASLD vs MASH: Where are you on the spectrum?
MASLD and MASH: Where are You on the Spectrum?
Having MASLD or non-alcoholic fatty liver disease means just that. The scan or MRI showed some fat around your liver. If you’re getting this early, there is probably no inflammation or cells injured. There is probably no fibrosis early on. That is a good thing. You can possibly make some health changes and reverse it. Sadly, there are no medications for MASLD (nah-full-dee) that have been approved by the FDA. We’ll talk more about that in another post.
Having NASH or non-alcoholic steatohepatitis means that your liver disease has progressed and now has more fat, and also has inflammation. There is injury to the cells in your liver. When a liver is inflamed and injured, that causes fibrosis and scarring.
The liver is only trying to heal itself, but the process of healing backfires. Just like a cut that gets a scab, and then scarring thickens the skin. Repeatedly getting cut in the same place will increase the thickness of the scar.
With the liver, the scar tissue is called fibrosis. It’s a thick fiber. The fiber grows like long bands of tissue that will move across the liver and attach itself to another spot. That’s part of the reason it is called bridging fibrosis.
Back to the Spectrum
If you think of the liver as being on a spectrum, you might be able to see a few things.
- How MASH progresses to MASLD
- What steps your medical team may take
- How you may be able to change the progression
The image above shows a healthy liver on the left. Follow the spectrum to the right. You will see a liver that is just at the beginning stages of MASH and showing some accumulation of fat. At this stage it is still reversible.
Even though the names have changed, you can tell by the next image that redness is indicating that inflammation is causing liver cell damage. Now it is moving from MASH to MASLD. Now cirrhosis sets in. These images may show what a liver looks like when it is not reversible. However, if the cause of inflammation is caught in time, your can have less inflammation and a healthier liver.
After the scarring has taken over the liver, it is more prone to liver cancer. I had hepatocellular carcinoma, and ended up with a transplant.
To Sum it All Up
Fat in the liver can be thought of as a spectrum, slowly getting worse over time. The damage can be halted with diet and lifestyle changes. Even if the scarring does not reverse, you can prevent even further damage. Living with cirrhosis is not an easy life. However, many areas of liver disease can be managed with medication, diet, and lifestyle. If you do get a tumor and have hepatocellular carcinoma or liver cancer – there is treatment available. I’ve lived through that.
Many people have successfully treated their tumor. Mine kept growing and I got more tumors. In the worse case, a liver transplant is possible.
I hope this helped clear up your mental picture of MASH and MASLD. Xo Karen
This image is from FEB press in the Wiley online journal. Liver macrophages and inflammation in physiology…
