Speaking with your PCP about MASH

MASH, formerly known as NASH, has been described as the most common disease you’ve never heard of. It stands for metabolic dysfunction-associated steatohepatitis. It’s hard to pronounce, harder to learn you are at risk. MASH is a serious form of fatty liver disease called metabolic dysfunction–associated steatotic liver disease (MASLD, which you have probably never heard of, either). Both conditions develop over time with very few symptoms. Believe it or not, MASLD (formerly called NAFLD) affects two billion people around the world, most of whom are already managing other medical conditions like diabetes, heart disease and/or weight issues. If that sounds like you or a loved one, it’s important to learn more about risk and MASH.

MASLD is a condition in which there is a buildup of fat in a liver. This process happens quietly. Over time, this buildup damages the liver. MASH occurs when ongoing inflammation leads to scarring (“fibrosis”) of the liver. This makes it harder for the liver to function effectively. And MASH that is unmanaged and progresses over time can lead to even more serious disease such as cancer.

Most MASH patients are middle-aged, already receiving care related to diabetes, and likely carrying some extra weight. For a person already living with other medical conditions, adding a new problem to the list – especially if it’s not causing any pain – is a tough sell. But as with so many things, knowledge is power.

Why has my doctor not talked to me about MASH?

There are many possibilities why MASH is not a more routine part of the doctor-patient conversation for at-risk patients. COVID has been very disruptive to primary care and reduced in-office visits for weight checks and physical observation.  Additionally, when it comes to MASH and risk, the best defense is a good offense: exercise and weight loss. A doctor that has already counseled a patient to lose weight for other reasons may not be sure what else to do.

What else is there?

A PCP deals with a broad range of medical issues and can’t be expected to know everything off the top of their head. A PCP should however help write the patient’s playbook. For someone ready to talk about MASH and personal risk or worry, a PCP can help in many ways once the patient has started, or accepted, the dialogue:

Ensuring an appropriate workup. What labs and trends are relevant and at what intervals?

Calling in the experts. Should any specialists be consulted and which ones, where, and in what order? Who would be the best fit for the patient based on their whole-person picture?

Root cause analysis. If a patient has not been successful in losing weight – why? Is there a limitation that physical therapy could help improve with a referral and support?

Staying current on trends and therapies. There is a lot of clinical research happening in MASH and the body of knowledge is growing. It is important for doctors to stay current on developments given the significant portion of a population that MASH is poised to impact.