Metabolic dysfunction-associated steatohepatitis (MASH) is an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD occurs when fat builds up in the liver, causing hepatitis (inflammation) and fibrosis (scarring) over time. At that stage, the condition has become MASH.

MASH may be reversible in its early stages, but untreated MASH can lead to cirrhosis (permanent liver scarring), liver cancer, and liver failure.

Taking action early to reverse the progression of MASH is extremely important.

In the early stages of MASH, there are several ways to slow down and possibly reverse fibrosis in your liver. In later stages of MASH, however, a liver transplant may be the only way to reverse liver damage.

Weight Loss Through Diet and Exercise

The best MASH treatment is typically weight loss because reducing your total body fat reduces the amount of fat that can build up in your liver. Losing weight also lowers inflammation. Depending on your current weight and other circumstances, your healthcare provider may recommend you try to lose 7-10% of your body weight over the next year.

The best ways to lose weight are eating a well-balanced diet and staying regularly active. Here are some tips:

• Work with your healthcare provider or a registered dietitian to set a daily calorie limit that is ideal for your body
• Focus on plant-based foods, whole grains, and healthy fats; cut out foods high in saturated fats, salt, and sugar
• Aim to get at least 30 minutes of moderate-intensity exercise on most days

Medications

Several types of medications can help reverse early liver damage that stems from fat buildup and inflammation. These medications work in different ways. Drugs your healthcare provider may prescribe include:

• Glucagon-like peptide-1 (GLP-1) agonists: These medications can help with weight loss. Providers also often prescribe these drugs to treat type 2 diabetes, which commonly occurs alongside MASH. Researchers are investigating several GLP-1 agonists for MASH treatment. Some are likely to reduce fat buildup and inflammation in the liver, and some may stop fibrosis from progressing. However, it is unclear whether these medications can help reverse MASH.
• Statins: These medications help control cholesterol levels.
• Rezdiffra (resmetirom): The United States Food and Drug Administration (FDA) has approved Rezdiffra to treat moderate to advanced fibrosis in people with MASH. This medication helps your body metabolize (break down) fat in the liver. It is a thyroid hormone receptor-beta (THR-beta) agonist.

Tell your provider about any other medications or supplements you are taking. Some drugs, like Rezdiffra and statins, may interact negatively when taken together.

Less Alcohol and More Coffee

Some liver damage is the direct result of drinking large amounts of alcohol. This condition is called alcohol-associated liver disease. Even people whose liver damage does not result from alcohol use, like those with MASH, should avoid drinking alcohol. Alcohol can be toxic to the liver and may make existing liver damage worse.

A beverage that may be good for MASLD—and its later stage of MASH—is coffee. Some research shows that two or more cups of caffeinated coffee daily can reduce the risk of fibrosis and liver cancer.

Bariatric Surgery

For people with obesity, bariatric surgery may help reverse MASLD. MASLD occurs in 50-90% of people with obesity. Bariatric surgery can help reduce body weight by an average of 15-30%. This reduces the risk of progressing to MASH and serious liver damage like cirrhosis.

A review of 30 studies showed that bariatric surgery reduced liver fat buildup seen via magnetic resonance imaging (MRI) by 72% after 6 months. The number of study participants with significant fibrosis decreased by about 18% after bariatric surgery.

Despite these positive effects on the liver, some studies suggest that people with MASH are at increased risk for worsening liver damage and even death after bariatric surgery. If you are a candidate for weight loss surgery, your healthcare provider can help you understand its potential risks.

Liver Transplant

People with advanced MASH may develop so much damage to their liver that it stops working effectively. This stage is called liver failure, and the only way to reverse it is with a liver transplant. MASH is one of the most common reasons for liver transplants in the U.S.

During a liver transplant, a surgeon removes the damaged liver. They then replace it with a new one (or part of a new one) from a donor. If you are able to keep your new liver healthy, a transplant can be life-saving.

However, liver damage can come back after a transplant. The risk of developing MASLD and MASH again depends on many factors, including other health conditions, genetics, and lifestyle habits.

MASH may be reversible in early stages, but the likelihood of being able to reverse it decreases as the disease progresses. Early action is essential to protect your liver health and avoid serious long-term complications.

Proper treatment can help the liver heal from minor damage, including fibrosis. Once cirrhosis develops, existing damage cannot be undone. Treatment at this stage helps slow down or stop the damage from progressing. However, there is currently no treatment that can cure or reverse cirrhosis. 

MASH progresses to cirrhosis about 25% of the time, but proper treatment allows many people with MASH to live long lives. Early diagnosis and long-term treatment may help you reverse existing liver damage. It is also important to manage related health conditions, like heart disease and type 2 diabetes.

Managing cardiovascular disease for a better MASH prognosis: Cardiovascular (heart) disease is the most common cause of death among people with MASLD. The two conditions often occur together and share several risk factors, such as obesity. Controlling cholesterol and blood pressure levels with a well-balanced diet, exercise, and medications can improve heart and liver health.

Managing type 2 diabetes for a better MASH prognosis: Type 2 diabetes is another condition that commonly occurs with MASLD and MASH. While also sharing risk factors like obesity, diabetes itself is considered a risk factor for MALSD. Both conditions involve insulin resistance, so controlling your diabetes by managing your blood sugar levels can help you prevent MASLD and MASH.

Some people with MASH may experience fatigue or pain near the liver (in the upper right abdomen). However, most people with MASH have no symptoms. This makes the condition hard to diagnose and start treating early.

Symptoms often begin to appear only when MASH has progressed to cirrhosis. Call your healthcare provider right away if you have any symptoms of cirrhosis, including:

• Spider veins or varices, visible blood vessels under the skin
• Poor appetite and unplanned weight loss
• Nausea and vomiting
• Jaundice, yellowing of the eyes or skin
• Ascites, an extremely swollen belly
• Hepatic encephalopathy, causing confusion or disorientation

If you begin to vomit blood, have black or tarry stools, or lose consciousness, go to the emergency room.

MASH is a serious liver disease that happens when too much fat builds up in the liver, causing inflammation and scarring.

Weight loss, medications, and managing related health conditions may help reverse damage from MASH in its early stages.

MASH can lead to cirrhosis or liver failure if left untreated. At this stage, MASH is likely not reversible, and you may need a liver transplant.