Understanding MASLD, formerly NAFLD
The new name for nonalcoholic fatty liver disease (NAFLD) is metabolic dysfunction-associated steatotic liver disease (MASLD). Over 200 liver disease experts made the name change in 2023.
Non-alcoholic fatty liver disease, now metabolic dysfunction-associated steatotic liver disease (MASLD), is a condition characterized by excess accumulation of fat in the liver that is not caused by alcoholic consumption. The deposition of this excess fat on hepatocytes causes a state of chronic inflammation, which leads to hepatocellular injury, fibrosis, and, eventually, cirrhosis.
MASLD is becoming more prevalent and has been attributed to rising obesity rates and poor dietary habits worldwide. High caloric intake, in combination with saturated/trans fat and refined carbohydrates, have all been associated with increased liver fat accumulation and inflammation.
The Gut Microbiome: from Eubiosis to Dysbiosis
The gut microbiome comprises the trillions of microorganisms that line our intestines, acting as modulators of digestion, immunity, and gastrointestinal homeostasis. The balance of healthy microbes (eubiosis) in the gut helps to establish the integrity of the intestinal-mucosal barrier and thereby protects the translocation of harmful pathogens and toxins into the bloodstream. When this balance is disturbed (dysbiosis), there is increased intestinal permeability, a hallmark finding in MASLD.
The heightened intestinal permeability seen in MASLD is widely known as the "leaky gut." A weakened intestinal barrier allows pathogens, bacteria, and inflammatory cytokines to translocate into the portal circulation, resulting in gut inflammation and dysbiosis.
Leaky gut syndrome is a hypothetical condition that’s not currently recognized as a medical diagnosis. It’s based on the concept of increased intestinal permeability, which occurs in some gastrointestinal diseases.
Read more on Leaky gut syndrome from the Cleveland Clinic.
The link between the Gut Microbiome and MASLD: the Gut--Liver axis
The portal vein facilitates the connection between the gut and the liver, often called the gut-liver axis. It transfers up to 75% of the blood from the intestines to the liver.
Additionally, it allows for the translocation of gut-derived metabolites. Pathogenic microbial transfer can influence liver metabolism and fat storage, creating a pro-inflammatory state. Chronic inflammation leads to the activation of hepatic stellate cells that transform into myofibroblasts and extracellular matrix components, leading to the development of liver fibrosis and, eventually, cirrhosis.
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Research into the treatment and prevention of MASLD is still ongoing. Still, dietary changes have been emphasized, including high fiber/low carb, probiotics, and prebiotics. These interventions address the gut dysbiosis seen in MASLD, helping to re-establish the gut-mucosal barrier and diminish the inflammatory response.
Prebiotics are digested by bacterial enzymes in the gut, which leads to an increase in the production of short-chain fatty acids (SCFAs), which act as critical modulators in the anti-inflammatory response.
Similarly, dietary fiber has been shown to increase the abundance of beneficial bacteria that produce SCFAs, further amplifying the anti-inflammatory response. Maintaining a diverse, balanced gut microbiome can reduce liver inflammation and excess fat accumulation and improve overall metabolic function.
Mayo Clinic Explains Cirrhosis | Check out this video.
Key takeaways
MASLD is characterized by an accumulation of excess fat on hepatocytes, not caused by alcoholic consumption.
Prevalence is on the rise and attributed to dietary habits and increasing obesity worldwide.
The gut microbiome maintains the integrity of the intestinal barrier and prevents harmful microbial translocation to the liver.
Chronic liver inflammation can lead to fibrosis and cirrhosis.
Dietary fiber and prebiotic & probiotic supplementation have been shown to maintain a healthy gut microbiome.
Maintaining a diverse & balanced gut microbiome can decrease inflammation and improve liver function.
Personally
I eat a high-fiber, mostly plant-based 🌱 diet, no red meat, drink 4 liters of water a day, exercise, and am focused on keeping nutrition simple. I am sharing what works for me and what I routinely recommend to my patients.
"Balance. Portion control. Keep nutrition simple. Eat Smart. Eat Healthy. 🌱 🌾 🌿"
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