Obesity-Related Liver Disease

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2.    Obesity-related liver disease, now increasingly referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), is the most common liver disease in Western countries and is directly linked to excess body weight and metabolic dysfunction. The disease starts with fat accumulation in the liver cells (steatosis), usually without symptoms, but can progress to nonalcoholic steatohepatitis (NASH), a condition characterized by inflammation and damage of liver cells.

3.    Obese individuals have a 2-to 3-times higher risk of having elevated liver enzymes. Risk of steatosis is up to 15 times higher in obese individuals compared to normal-weight people. It’s dose-dependent: a 20% increase in NAFLD risk per 1-unit increase in BMI. Mechanisms of obesity include adipose tissue dysfunction, insulin resistance, and increased inflammation.
Progression can lead to advanced fibrosis, cirrhosis (cryptogenic cirrhosis), and hepatocellular carcinoma. The disease is also associated with increased cardiovascular mortality. Risk factors include obesity (BMI >30), type 2 diabetes, high triglycerides, and abdominal obesity.
The cornerstone of management is weight loss (0.5–1 kg/week recommended). Lifestyle changes, including a healthy diet, regular exercise, avoidance of alcohol, and control of diabetes, can halt or reverse damage. In the event of failure of lifestyle changes, anti-obesity medications and bariatric interventions lead to significant weight loss and improve liver steatosis and fibrosis.