From the Research
Approximately 39% of patients with metabolic-associated steatotic liver disease (MASLD) will progress to cirrhosis over time, as reported in a recent study 1. This progression typically occurs over decades and is not uniform across all patients. Risk factors that increase the likelihood of progression to cirrhosis include:
- Older age
- Presence of diabetes
- Obesity
- Genetic factors
- Persistent liver inflammation The development of cirrhosis in MASLD patients is concerning because it represents advanced liver scarring that can lead to liver failure, portal hypertension, and increased risk of liver cancer. The progression from simple fatty liver to cirrhosis usually passes through stages of increasing fibrosis, with many patients showing a slow progression rate of about one fibrosis stage every 7-10 years. However, some patients may progress more rapidly, especially those with multiple metabolic risk factors or genetic predispositions. Regular monitoring of liver function and fibrosis assessment is important for MASLD patients to identify those who may be progressing toward cirrhosis and who might benefit from more aggressive lifestyle interventions or emerging pharmacological treatments, such as vitamin E and pioglitazone, which have shown some beneficial effects in reducing steatosis, inflammation, and ballooning 2. It is essential to note that the cumulative risk of mortality for NAFLD, NAFLD cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma is significant, highlighting the need for early diagnosis and treatment 1. Overall, the management of MASLD requires a comprehensive approach, including lifestyle modifications, monitoring of liver function, and consideration of pharmacological treatments to prevent progression to cirrhosis and improve patient outcomes.