saudigastro.com/patients/mash-steatohepatitis
Category
Chronic
Red flags
4
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
MASH stands for metabolic dysfunction-associated steatohepatitis. It was previously called NASH. Many adults have fat in the liver (steatotic liver disease linked to metabolic health). In some, the fat is accompanied by inflammation and injury to liver cells; this is MASH. Over time MASH can lead to fibrosis (scarring) and, in some people, cirrhosis (advanced scarring) and liver cancer. It is not caused by alcohol.
How common is it?
Fatty liver is one of the most common liver conditions in the world, and it is increasing along with obesity and type 2 diabetes. Only a portion of people with fatty liver have MASH, and only some of them develop advanced scarring. Many are unaware because there are often no symptoms.
Why does it happen?
It is closely linked to insulin resistance (the body responding poorly to insulin), excess weight especially around the waist, type 2 diabetes, high blood pressure and abnormal blood fats. A diet high in sugary drinks and refined foods and low physical activity contribute. Genes also play a role, which is why some people are affected despite a healthy weight.
Symptoms
- Usually no symptoms
- Tiredness
- Dull discomfort in the upper right abdomen
- Abnormal liver blood tests found by chance
- Later, if cirrhosis develops: jaundice, swelling, itching, easy bruising
Red flags — seek urgent medical care
Vomiting blood or black stools
Possible bleeding from cirrhosis. Go to the emergency department now.
Confusion or marked sleepiness
May indicate advanced liver failure. Emergency care is needed.
Yellow skin or eyes, or a swollen belly
May signal advanced liver disease. See a doctor promptly.
Fever with abdominal pain in someone with fluid in the belly
Possible infection of the fluid. Seek urgent care.
How is it diagnosed?
Fatty liver is often found on ultrasound or from abnormal liver blood tests. The doctor rules out other causes, such as alcohol and viral hepatitis. Then the aim is to estimate scarring using blood-based scores and FibroScan (a painless stiffness test). A liver biopsy, taking a tiny sample, is the most direct way to confirm MASH and is used when other tests are unclear. Blood sugar and cholesterol are also checked.
What the latest science says
Research on MASH is active. Weight loss, particularly when sustained, improves liver inflammation and can reduce scarring. Some medicines are now being approved or studied for MASH with scarring; ask your specialist what is suitable for you.
Outlook — what to expect
Many people never develop serious liver disease, but those with significant scarring need closer follow-up. Heart disease is also a major risk in people with MASH, so protecting the heart and treating diabetes and blood pressure are part of care. Lifestyle changes can improve or even reverse liver changes.
Treatment
Habits & Lifestyle
Lifestyle change is the foundation of treatment.
- Gradual, steady weight loss; a modest loss already helps, and more helps more
- Regular physical activity, including walking and some strength exercises, as your doctor allows
- Avoid alcohol or keep it to what your doctor advises
- Stop smoking
- Sleep well and manage stress
Diet
A Mediterranean-style way of eating is well supported.
- Eat more vegetables, fruit, legumes, whole grains, fish and nuts
- Use olive oil in place of butter or ghee where possible
- Avoid sugary drinks, juices and sweets, including sweet desserts and dates in large amounts
- Limit processed meat, fried food and refined white flour
- Coffee in moderation may be beneficial; ask your doctor
Medications
Treatment of MASH also means treating diabetes, blood pressure and cholesterol. Your doctor decides which medicines suit you.
- Some diabetes medicines may also benefit the liver; your doctor will choose for you
- Newer medicines for MASH with moderate to advanced scarring may be available; ask your specialist
- Statins for cholesterol are generally considered safe in fatty liver, as your doctor advises
- Do not use herbal "liver cleanse" products or supplements without asking
Procedures & Surgery
Procedures are for selected patients.
- Bariatric (weight-loss) surgery or endoscopic weight-loss procedures for suitable people with severe obesity
- Liver biopsy or FibroScan to stage scarring
- Ultrasound surveillance for liver cancer and endoscopy for veins if cirrhosis develops
- Liver transplant in end-stage disease
In the Saudi context
Sugary drinks, sweets and large portions at gatherings and during Ramadan evenings can add up. Choosing water, lean protein, vegetables and smaller portions of dates and desserts helps. If you have diabetes and plan to fast, discuss it with your doctor beforehand.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How much scarring do I have?
- What weight-loss goal is realistic for me?
- Do I need a biopsy or FibroScan?
- Are there medicines for MASH that suit me?
- How often should my liver be checked?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide