10 Things That Can Predict the Progression of Fatty Liver Disease

The progression of fibrosis is unique to each person. For some people it can be slow and last decades, especially if caught at stage 0 or stage 1 when you can make lifestyle changes. There's a higher risk of developing cirrhosis, the most severe fibrosis, at stage 2 and a much higher risk at stage 3. About 20% of people in stage 3 develop cirrhosis within two years.

There are many links between MASH and other medical conditions, especially those that make up metabolic syndrome like belly fat and high cholesterol. Some can cause and worsen MASH, and MASH can cause some of them to develop. By managing each one, you can control them and keep MASH from worsening. It’s not as complex as it might seem: You can get great results with lifestyle choices and, when needed, medication.

The same diet high in saturated fats and sugars that leads to fatty liver can amp up fibrosis progression, even if you’re at a healthy weight. There’s no specific eating plan for MASH, but the Mediterranean diet gets high marks for being liver-friendly. You focus on foods like veggies, fruit, and whole grains and eat less meat, salty foods, and sugary drinks. This reins in MASH as well as what drives it: diabetes, cholesterol, and high blood pressure.

In addition to sugary drinks, avoid all types of alcohol, from beer to hard liquor. Research has linked even moderate drinking to fibrosis progression. There’s no known safe amount of alcohol to drink at any point along the journey from fatty liver to MASH. On the other hand, two or three cups of coffee, especially black, is protective. It can reduce the amount of fat in the liver, inflammation levels, and the risk for fibrosis progression.

Fatty liver is linked to a lack of physical activity. Getting fit is one of the best ways to control MASH and its related conditions. The goal is 30 minutes of moderate exercise on most days, and you can even break that into 10-minute chunks to fit your schedule. If you’ve been sedentary, start with just five or 10 minutes a day and build from there. Talk to your doctor about safe options and choose ones you enjoy so you’ll stick with the plan.

This is especially important if you have belly fat and a BMI over 30. Overweight and the inflammation it causes are key drivers of MASH, but losing 5% to 10% of your body weight can control and possibly reverse it. If diet and exercise don’t help, ask your doctor about GLP-1 drugs. They can help increase weight loss and reduce inflammation and fat in your liver. This used to require bariatric surgery, which is another option.

MASH and type 2 diabetes can feed off each other. MASH ups the risk for diabetes, and having diabetes increases the risk of worsening fibrosis. Between 42% and 70% of people with type 2 diabetes have MASH, and about 23% of people with MASH also have diabetes. When you have both, you have a higher degree of insulin resistance than with diabetes alone. Make sure your diabetes is well controlled with medications — GLP-1s can be effective for both diabetes and MASH — and by tracking your blood glucose levels.

If you have high levels of LDL (“bad”) cholesterol and high triglycerides, and low levels of HDL (“good”) cholesterol, you’re at risk for MASH. A diet low in saturated fat, primarily from plant-based foods, will help. Unsaturated fats found in olive oil, nuts, and seeds as well as fatty fish, can protect your liver. Medications to lower cholesterol and/or triglycerides could be an important part of your plan; take them consistently.

High blood pressure is a big part of metabolic syndrome, and uncontrolled blood pressure is another risk factor for fibrosis progression. Among people with MASH, 73.9% had high blood pressure. Improve your diet and get exercise, both of which help with MASH, to lower your blood pressure. You may also need to take blood pressure-lowering medications. Sticking with them is a must since high blood pressure usually has no symptoms.

An imbalance between good and bad bacteria in the gut is another influencer when it comes to worsening fibrosis. You can rebalance the scales by adding more fiber to your diet. In one study, getting at least 7.5 grams of insoluble fiber a day improved three different markers of liver fibrosis. Good sources of insoluble fiber are whole wheat flour, wheat bran, nuts, beans, and cruciferous vegetables such as cauliflower.

Polycystic ovary syndrome (PCOS) and sleep apnea are lesser-known risk factors for MASH progression. There’s also a connection between an underactive thyroid and MASH and between an underactive pituitary gland and MASH. Ask your doctor if you should be tested for these conditions and, if you have any, how best to treat them.

Advanced age is a risk for MASH progression. You can’t change the genetic risks: People of Hispanic descent are at greater risk than other groups. So are people with a first-degree relative who has cirrhosis from MASH. Research has found specific genes responsible for fatty liver, and this may help in the development of targeted treatments. For now, knowing your genetic profile can be motivation to do everything within your control to fight MASH.

Make sure you’re up-to-date on vaccines that safeguard liver health like hepatitis A and B. Review all over-the-counter medications and supplements you take with your team — you may need to stop some of them. Even important nutrients, like vitamin A, iron, and niacin can be harmful to your liver in high doses. So can some pain relievers, including acetaminophen, aspirin, and ibuprofen. Some herbal remedies are especially risky.

Tests can show if your liver is responding to treatment or getting worse. While you might have had a liver biopsy as part of your diagnosis, your doctor will likely use less invasive tests. Blood tests can measure liver enzyme levels. Imaging tests like liver elastography (FibroScan) looks at how stiff the liver is. Work with your doctor to know how often you might need these and other tests to see if fibrosis has improved or at least stayed the same.