Fatty liver disease (MASLD) – Survival rates

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are liver conditions that are becoming more common, especially in people with obesity, diabetes, high blood pressure and high cholesterol. These diseases used to be called nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), but experts updated the names to better reflect their connection to metabolic health.

MASLD means your liver has too much fat. This can happen even if you don’t drink alcohol. MASLD is often found in people who are overweight or have diabetes. More than one-third of the world’s population has MASLD.

MASH is a more serious form of liver disease. It means your liver is not only fatty but also inflamed and damaged.

Which of these liver conditions you have, along with several other factors, is key to understanding your outlook, also called prognosis.

Understanding MASLD and MASH outcomes

Many people with MASLD don’t have liver-related complications, especially if they lessen their metabolic risk factors. Research shows that people with MASLD live, on average, about three years less than those without the condition. MASLD can raise the risk of heart disease and certain types of cancer. And up to 20% to 30% of people with MASLD may develop MASH.

With MASH, inflammation and damage can lead to scarring, also called fibrosis; cirrhosis, which is severe scarring; and liver cancer over time. These conditions have a great impact on survival rates.

Factors influencing outcomes

Healthcare professionals use a system called fibrosis staging, from F0 to F4, to measure how much damage there is in the liver.

People with F3 or F4 fibrosis are at greater risk of liver failure and cancer. The average 10-year survival rates reflect this.

• F0 to F2: About 89% to 93%.
• F3: About 81%.
• F4, also called cirrhosis: Around 51%, depending on complications.

Worsening of scarring to cirrhosis is typically slow, taking years to decades. On average, people with MASH move to the next stage of fibrosis approximately every seven years, compared with every 14 years in those with MASLD.

People who have liver scarring without major complications, called compensated cirrhosis, have higher survival rates than those with scarring with major complications, known as decompensated cirrhosis. Complications include abdominal fluid buildup, called ascites; gastrointestinal bleeding, also called variceal bleeding; and confusion, known as hepatic encephalopathy. For people with decompensated cirrhosis, average survival time is 2 to 3 years without receiving a liver transplant.

Other factors affecting prognosis include:

Heart health. Heart disease is the No. 1 cause of death in people with MASLD or MASH. That’s because these liver conditions often come with high blood pressure, high cholesterol, and diabetes — all of which hurt the heart.

Diabetes and obesity. Having diabetes or being overweight worsens liver health. It also raises the risk of kidney issues and other health concerns.

Age and sex assigned at birth. Older people tend to have more liver damage. Men may be more likely to develop serious scarring, while women may have more fat in the liver but slower progression until they reach menopause.

Lifestyle. Drinking alcohol, eating less healthy food and not exercising can make liver disease worse. But healthy habits can slow or even reverse damage.

Genes. Some people have genetic traits that make them more likely to get liver damage. Researchers are still learning how to use this information to help people with liver conditions.

The good news is that MASLD and MASH can often be managed — and sometimes improved — with lifestyle changes. For example, losing just 7% to 10% of your body weight can reduce liver fat and inflammation. Eating a Mediterranean-style diet that includes lots of fruits, veggies, whole grains and healthy fats can also improve liver health.