You could unknowingly have this dangerous liver disease. Here's what to do

MASLD, previously called ‘fatty liver disease’, is a ticking timebomb, affecting 30 to 40 per cent of adults – most of whom don’t know they have it

We all know we should be eating more healthily and have a pretty good grasp of why. Cutting down on junk food and turning to more wholesome options in the pursuit of looking or feeling a bit better is nothing new. But what fewer people might realise is that it could heal your liver too.

The liver is a remarkable organ, performing hundreds of metabolic and support functions, such as the production of important proteins destined for the blood and the processing and detoxification of chemical substances from food and drugs.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an epidemic. Around 30 to 40 per cent of adults have it, which works out to around two billion people worldwide.

Too much processed food, high in fat, sugar and refined carbohydrates, can lead to liver disease MASLD (Picture: Joe Raedle) | Getty Images

Can lead to cancer

In this condition, liver cells known as hepatocytes accumulate tiny fat droplets, which can eventually impair metabolic function and damage your liver. Unfortunately, there are few therapeutic interventions to effectively treat this common and potentially dangerous disease.

When you are immersed in a subject as an academic, it can be easy to forget that things which form the very basis of your work aren’t so widely known. But frequently, when I mention those numbers to people, they’re surprised.

The condition itself is a ticking time-bomb, as it can develop into a more serious form, an inflammatory phase called metabolic dysfunction-associated steatohepatitis (MASH), that drives liver scarring (fibrosis), cirrhosis or even cancer.

An uncomplaining organ

It often goes hand-in-hand with other conditions, particularly heart disease. However, the liver is an uncomplaining organ and MASLD rarely has noticeable symptoms in the early stages. Spotting it can be quite tricky.

There are some liver-related blood tests and an ultrasound test, but these aren’t necessarily conclusive. There is an invasive biopsy, involving a long needle, which is a definitive clinical test. However, biopsies are often a last resort, and not without some risk. Besides, patients undergoing such tests may often already be at an advanced stage of liver disease.

Currently, there is a lack of diagnostic and prognostic indicators, which means that it is difficult to catch early and treat.

Looking for tell-tale signs

At Edinburgh Napier University, I am leading a project called Halt-RONIN with colleagues at the University of Edinburgh that’s looking for biomarkers – small molecules found in the liver and secreted into blood – to tell whether you have MASLD much earlier. Discovering one would give healthcare professionals the tools and knowledge to establish guidelines for prevention and treatment at each stage of illness.

Our efforts to find these indicators are wide-reaching. We are using clinical liver tissue data from centres across Europe, including one here in Edinburgh. We are modelling data using artificial intelligence to establish any patterns in our lab models of MASLD-MASH and in people who develop MASLD.

We even have technology known as a ‘liver-on-a-chip’, a miniaturised device which mimics the structure and function of the human liver and allows us to model human liver disease.

As well as trying to fill gaps in the diagnosis of MASLD, the research also aims to understand the bodily mechanisms which lead to the transition to the more serious MASH. We hope that our project will provide a better understanding of the disease mechanisms and lead to the development of effective drugs.

Currently, MASLD is not something which can be routinely tackled with medication. Notably, however, the US Food and Drug Administration-approved drug, Resmetirom, has been tested as a specific treatment for MASH in some patients, while other drugs for type-2 diabetes and weight management hold promise.

‘Food is medicine’

Which brings us back to diet. Today is World Liver Day, which this year has the theme “food is medicine”. While people may more frequently associate the liver with alcohol-related diseases, what you eat has a profound effect on how it functions.

Our Western diets, high in sugar, refined carbohydrates and fats – present in processed foods – lead, in time, to droplets of fat building up in the liver and causing inflammation. But the good news is that some elements of this damage can be reversed by eating more healthily.

Foods rich in fibre, healthy fats, and lean protein – such as grains, leafy greens, nuts, and fish – can reduce inflammation and fat content. Happily, coffee consumption has also been shown to have beneficial effects.

As well as preventing MASLD, these types of dietary changes maintain the function of your liver when it comes to processing things like alcohol and over-the-counter medication.

Society needs to change

Of course, making lasting dietary changes is much easier for some people than others. As the organisations behind the World Liver Day campaign note, the economic barriers to accessing fresh, nutrient-rich foods instead of their widely available, ultra-processed alternatives play a role in the growing numbers affected by MASLD. Any solutions need to be broad and societal, as well as clinical.

Nonetheless, our work to tackle this continues. Having analysed the clinical data of people with the condition, we are optimistic that certain proteins in the blood could serve as biomarkers of liver disease. Our team in Edinburgh is part of a big, Europe-wide consortium working on this and we are hopeful it will make a difference to the way these conditions are diagnosed and treated in future.

With more research, we hope to find new, non-invasive ways of detecting MASLD-MASH associated inflammation at an early stage so that more people can reverse it, ideally through lifestyle modifications, including diet and exercise. Given the number of people affected by this disease and the subsequent health problems it can lead to, the impact such a development could have on our health services is enormous.

In the meantime, though, if it encourages you to avoid the odd takeaway in favour of something healthier, your liver will be all the better for it.

Leonard Nelson is professor of human liver biological engineering at Edinburgh Napier University. The Halt-RONIN project is funded by UK Research and Innovation, and Horizon Europe.