Diabetes and Metabolic Dysfunction-Associated Steatohepatitis -

If you have diabetes, you probably know the condition is linked to a greater risk of several health problems, including heart disease, kidney disease, nerve damage, and more. But one risk you may not be as familiar with is metabolic dysfunction–associated steatohepatitis (MASH).

MASH is typically linked to metabolic syndrome, a group of conditions associated with the development of heart disease and type 2 diabetes, such as high blood pressure. “The most prominent associated risk factor for MASH is obesity,” says Jonathan Jennings, MD, an internist at Medical Offices of Manhattan in New York City. “Researchers suspect chronic inflammation from the excessive fat plays a prominent role in the development of MASH.”

Having type 2 diabetes is also linked to MASH. Among adults over age 50 with type 2 diabetes and MASH, about 14 percent may be candidates for MASH treatment, which is currently indicated for liver fibrosis stages 2 and 3 (fibrosis is staged from 0 [none] to 4 [cirrhosis]).

Here’s what you should know about MASH if you have diabetes.

1. Insulin Resistance Increases Your Risk of MASH

Type 2 diabetes is characterized by insulin resistance, a condition where the body is unable to respond to insulin — a hormone that plays a crucial role in regulating blood sugar. This leads to elevated blood sugar levels (hyperglycemia).

“Over time, insulin resistance and hyperglycemia lead to damage in the liver through an accumulation of fat and inflammation,” says Michele Yeung, MD, an endocrinologist at the Innovative Center for Health and Nutrition in Gastroenterology at Weill Cornell Medicine in New York City.

2. Other Health Issues Can Also Increase Your MASH Risk

Obesity is the top risk factor for MASH, but there are others, which are also often tied to type 2 diabetes. These include:

High blood pressure
High cholesterol
Polycystic ovary syndrome
Underactive pituitary gland
Underactive thyroid
Being over age 40
Being postmenopausal

3. MASH Is Often Found Through Routine Screenings

MASH usually has no symptoms, so “Many people are often diagnosed incidentally through screening imaging studies like an ultrasound,” says Dr. Jennings. Blood work may also help identify this common liver disease.

If you have risk factors for MASH, it’s important to stay on top of your regular checkups, so your doctor can monitor you for signs of liver disease.

If your doctor suspects MASH, “The most definitive way to make the diagnosis is with a small tissue biopsy of the liver,” he adds. But with the emergence of accurate noninvasive tests, such as a FibroScan or blood-based biomarker tests, biopsies are becoming less common.

4. MASH Symptoms May Not Be Obvious

Although most people with MASH don’t experience symptoms, the most common complaints include:

Fatigue
Itching
Loss of appetite
Stomach pain
Weakness

It can be hard to pinpoint the cause of these symptoms, because they are common in so many diseases. That said, experiencing other symptoms, such as changes in the color of your eyes and skin, may suggest the liver has sustained more significant damage. In that case, you should call your doctor, says Jennings.

5. Early Stages of MASH Can Sometimes Be Reversed

“Routine screening is important, because early stages of MASH can be reversible in some cases,” Dr. Yeung notes. “Therefore, early diagnosis and intervention is critical for long-term management.” So if you have diabetes or other health conditions that increase your risk of MASH, it’s important to stay on top of your scheduled checkups to monitor your liver health. The American Association of Clinical Endocrinology recommends that all adults with diabetes be screened for MASLD/MASH, using sequential testing with blood work, followed by a FibroScan.

6. Undiagnosed and Untreated MASH Can Affect Your Overall Health

MASH itself isn’t life threatening, but when it occurs along with other risk factors, it can increase the risk of progression to end-stage liver disease, which is terminal. It can also increase your risk for liver cancer and heart disease.

7. Taking Steps to Manage Diabetes Can Help Reduce Your MASH Risk

The good news? The steps you may already take to manage diabetes can help lower your risk for MASH, too. These steps can include:

Losing weight: Specialists recommend a 10 percent reduction in body weight to reduce the amount of liver fibrosis. But just a 5 percent reduction in weight can lower inflammation or fat in the liver, Jennings notes.
Eating healthy and exercising: The best way to lose weight — and keep it off — is through a nutritious diet and regular exercise. Your doctor may refer you to a registered dietitian or exercise professional and recommend other resources to help you get started.
Avoiding alcohol: Because your liver is already taxed from MASH, it’s important to abstain from alcohol to avoid further injury to your liver. This is especially important if you have stage 2 liver fibrosis or more advanced disease.
Taking all medications as prescribed: Follow all directions for any treatments you’re prescribed, including for diabetes and other health conditions you’re managing. If you have moderate-to-advanced liver scarring from MASH, your doctor may prescribe a treatment for that, too.

“The silver lining is, because type 2 diabetes and MASH are so interconnected, both conditions can be treated together,” says Yeung. “Work together with your treatment team to decide on the best approach.”

The Takeaway

People who have type 2 diabetes are at greater risk of developing MASH, a form of steatotic liver disease.
MASH often has no symptoms, but it can be detected through routine screenings. So it’s important to stay on top of routine doctor visits to monitor your liver health.
Early diagnosis is key, as MASH may be reversible if caught early. Left untreated, it can lead to severe liver damage.
Following a healthy lifestyle — eating a balanced diet, staying active, maintaining a healthy weight — and staying on top of diabetes management can also help lower your risk of developing MASH.

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