Metabolic dysfunction-associated steatohepatitis (MASH)
ICD-10 K75.81
- ~0-30%
- US adult MASLD prevalence
- ~0%
- have MASH (progressive form)
- 0-10%
- weight loss reverses MASH in most
- 04
- Rezdiffra first FDA-approved MASH drug
What is metabolic dysfunction-associated steatohepatitis (mash)?
MASH (formerly NASH) is the inflammatory form of metabolic dysfunction-associated fatty liver disease (MASLD). Characterized by hepatic steatosis plus inflammation and hepatocyte injury, with risk of progression to cirrhosis. Tightly linked to obesity, T2D, and metabolic syndrome. Renamed from NASH in 2023 (American Association for the Study of Liver Diseases consensus).
What are the symptoms of metabolic dysfunction-associated steatohepatitis (mash)?
- Most patients are asymptomatic — discovered on routine labs (elevated ALT/AST) or imaging
- Vague right upper quadrant discomfort or fullness
- Fatigue (non-specific)
- Advanced fibrosis/cirrhosis symptoms: jaundice, ascites, easy bruising (late-stage only)
Who is at risk for metabolic dysfunction-associated steatohepatitis (mash)?
- Obesity (BMI ≥30 — 75%+ of MASH patients are obese)
- Type 2 diabetes or prediabetes
- Hypertension
- Dyslipidemia (especially high triglycerides)
- Metabolic syndrome (3+ of the above)
- Hispanic ancestry (higher US prevalence)
- PCOS in women
How is metabolic dysfunction-associated steatohepatitis (mash) diagnosed?
Suspected when imaging (ultrasound, MRI-PDFF, or transient elastography) shows hepatic steatosis in adults with cardiometabolic risk factors. Confirmed historically by liver biopsy showing steatosis + lobular inflammation + ballooning hepatocytes. Newer non-invasive scoring (FIB-4, NAFLD fibrosis score, MAST score) increasingly supplants biopsy.
How is metabolic dysfunction-associated steatohepatitis (mash) treated?
Weight loss is the most evidence-supported intervention: 7-10% body weight loss reverses MASH in most patients. GLP-1 receptor agonists (semaglutide, tirzepatide) show histologic improvement in trials and are first-line where comorbid obesity or T2D exists. Resmetirom (Rezdiffra, FDA-approved 2024) is the first MASH-specific drug. Bariatric surgery for severe disease with concurrent severe obesity.
Medications used for metabolic dysfunction-associated steatohepatitis (mash)
Authority reference: www.aasld.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Semaglutide in Patients with Cirrhotic and Non-Cirrhotic NASH (ESSENCE Phase 3 interim) · New England Journal of Medicine, 2024 · PMID 39718336
- Resmetirom for Nonalcoholic Steatohepatitis (MAESTRO-NASH) · New England Journal of Medicine, 2024 · PMID 38324483
- AASLD Practice Guidance on the Clinical Assessment and Management of NAFLD · Hepatology, 2023 · PMID 36926958
People also ask
What's the difference between MASLD and MASH?
MASLD (metabolic dysfunction-associated steatotic liver disease) is the umbrella term for steatosis with metabolic risk factors — replaces the older NAFLD nomenclature. MASH (metabolic dysfunction-associated steatohepatitis) is the progressive form with active inflammation and hepatocyte ballooning, ~5% of MASLD patients. MASH carries fibrosis-progression risk; pure steatosis without MASH usually does not.
Will losing weight reverse my fatty liver?
Yes — 7-10% sustained body-weight loss reverses MASH in most patients with concurrent improvement in fibrosis. GLP-1 receptor agonists (semaglutide, tirzepatide) produce this magnitude of weight loss reliably and have direct hepatic anti-inflammatory effects beyond the weight component in trials.
Is Rezdiffra (resmetirom) the same as a GLP-1?
No. Rezdiffra (resmetirom) is a thyroid hormone receptor β agonist — a different mechanism. It's FDA-approved (2024) specifically for non-cirrhotic MASH with significant fibrosis. GLP-1s are not MASH-labeled but are increasingly used for the overlap of obesity, T2D, and MASH where weight loss is itself the treatment.
Should I avoid alcohol if I have MASH?
Yes. MASH and alcohol-related liver disease are synergistic — even moderate alcohol amplifies MASH progression. Most hepatology guidance recommends abstinence or very minimal use (≤1 drink/week) in established MASH, particularly with any fibrosis.