But doctor, I have a normal body weight, and I do not drink alcohol; how come I am diagnosed with MASLD?
MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) does not always occur because of obesity and consumption of alcohol. It can also occur in individuals with a normal body mass index and lean people. A person weighing 65kg, which is a normal body mass, can have subtle metabolic problems, disrupted triglycerides, and increased waist circumference, which cause excess storage of fat in the liver or the abdominal organs. Lean MASLD has gradual symptoms, which is why it takes time for one to notice a disorder in their body, and it results in higher risks, as such lean people are not exempt from experiencing MASLD.
As such, it’s possible to have a healthy body weight and still have a higher risk of lean MASLD, which is mostly found in adults aged 60 and older. After thorough diagnosis, one may be able to receive treatments for fatty liver in lean people in Ludhiana to restore functionality, address inflammation and the underlying health problems. This blog answers a number of common questions associated with lean MASLD.
Lean MASLD
Lean MASLD is real and is often unexpected; it is when the liver has an accumulation of fat that is more than 5% of the normal body mass (BMI) caused by metabolic risk factors. MASLD(Metabolic Dysfunction-Associated Steatotic Liver Disease) is the now-known medical name for Non-alcoholic Fatty Liver Disease (NAFLD). A person may have a normal body weight but still have MASLD, which occurs because of metabolic dysfunction and other genetic factors.
If the symptoms are subtle, what red flags should you take note of?
Fatty liver may be silent, but it does leave some hints as it progresses; you can look out for symptoms like;
- Sudden drowsiness or confusion
- Unexplained swelling of legs
- Releasing black or tarry stool and vomiting blood
- Unexplained and persistent swelling of the abdomen
- Persistent fatigue even after resting
- Yellowing of the skin and eyes
The problem with these symptoms is that they are similar to other health problems and can be mistaken for other health conditions, which is why thorough diagnosis is required.
The main differences between obese MASLD and lean MASLD
- Obese MASLD is generally caused by excess body fat, high calorie intake and systemic calorie intake, whilst lean MASLD is driven by genetic factors and hidden internal fat.
- Obese MASLD is associated with high blood sugar, triglycerides and overt metabolic syndrome, whilst lean MASLD exhibits higher fasting blood sugar and lipid imbalances.
Who is more susceptible to lean MASLD
- Lean MASLD can be diagnosed in various regions, but it has been notably prevalent in Asian regions.
- Individuals with some genetic health problems may register normal body weight with the presence of hidden fatty liver.
- Individuals may experience abnormal metabolic conditions such as unhealthy lipids, insulin resistance and type 2 diabetes.
- Individuals experiencing co-existing health problems such as PCOS can have a disrupted metabolism.
How does lean MASLD occur
Belly fat(Visceral adiposity): Lean MASLD can occur when an individual has an accumulation of body fat deep inside the abdomen wrapped around the organs, causing a release of fatty acids directly into the liver.
Insulin resistance: The body cells may experience a problem responding to insulin, which causes the body to release more insulin, which causes the liver to turn excess carbohydrates into stored fat.
Genetic factors: Some genetic changes in the body make individuals more vulnerable to storing fat in the liver and causing inflammation.
Dietary factors: Individuals who have high consumption of processed sugar and ultra-processed food cause liver fat production, which causes harmful changes in the gut.
What are the diagnostic measures and treatments involved?
Lean MASLD can be reversed at its early stages with lifestyle changes, addressing metabolic abnormalities, reducing visceral fat and addressing other medical conditions that are triggering fatty liver.
Lifestyle and dietary modifications
Engaging in regular exercise: Value ongoing exercise every week that involves cardio and resistance exercises to build body mass and to improve sensitivity to insulin.
Adopting a Mediterranean diet: The individual is encouraged to incorporate a diet that is high in fiber, vegetables, legumes, fish and olive oil and to stay away from highly processed food.
Avoid excessive weight loss: In order to prevent muscle loss, it is important to avoid excessive weight loss.
Managing underlying conditions
Addressing metabolic risk factors: Ensure you undergo active treatment for factors that disrupt metabolic problems such as type2 diabetes, triglycerides, and high cholesterol from trusted specialists.
Medications and supplements
Targeted medications: The medications are prescribed in order to deal with inflammation and significant fibrosis.
Avoid unproven supplements: It’s best to avoid unverified liver detox supplements or herbal tonics because they mostly carry a risk of drug-induced liver injury.
Blood tests: An individual is expected to undergo liver function tests, which involve a metabolic panel of blood glucose and lipid profile to analyse the functionality of the liver.
Abdominal ultrasound: This test involves the use of advanced tools to detect visible fat that has accumulated in the liver.
Fibro scan: This test involves the evaluation of liver stiffness to quantify liver fat non-invasively.
MRI-PDFF: This test is done to confirm liver quantification when non-invasive fat quantification is non-conclusive.
Liver Biopsy: This exam is done to analyze complex conditions where the doctors have to rule out underlying factors.
The misconceptions to take note of about Fatty liver in lean people
Myth: Fatty liver in lean people is not harmless
Fact: Fatty liver in lean people is considered dangerous because it has slow symptoms; hence, diagnosis takes longer.
Myth: Fatty liver is only found in Asians
Fact: Fatty liver in lean people is prevalent in the Asian region but is not limited to a region; anyone can be susceptible to it.
Myth: fatty liver will cause pain at its early stage.
Fact: Fatty liver in lean people takes time to start showing symptoms; hence, pain starts as the damage progresses and not at the initial stages.
Here is a checklist of what you can do if the diagnosis indicates ‘fatty liver”
- Start maintaining physical activity.
- Get to know what you can change about your diet.
- Take time to learn about your metabolic health, what causes any disruptions, and how you can take care of it with a certified health professional.
- Get to know if you have any health conditions and the treatments needed to be done.
- Get to know if your blood sugar and lipid profile are checked.
Bottom line
A healthy weight does not exempt an individual from MASLD, but taking care of the metabolic system can significantly reduce the chances of experiencing it.
Fatty liver in lean people has a higher chance of causing damage because the symptoms are not so obvious, which is why it is important to undergo frequent diagnostic tests and pay attention to your body so that you can notice the subtle symptoms and seek treatment at Ameritus Hospital, where Dr Kartik Goyal and his team of specialists can conduct various treatments to reverse symptoms, restore functionality and address underlying symptoms.
FAQ’s
- Why is lean MASLD considered dangerous compared to obese MASLD?
Lean MASLD is considered to be dangerous because it has slow symptoms, which lead to delayed diagnosis, causing higher risks.
- What happens when MASLD is left untreated?
Untreated fatty liver causes an increase in the accumulation of fat, which leads to progressive liver damage and chronic complications that pose a threat to one’s health.
- What are the best ways to improve insulin sensitivity in the body?
In order to improve insulin sensitivity, it’s advised to engage in exercise, incorporate a nutrient-rich diet, rest and manage stress.
- How does a disrupted lipid profile and triglyceride disruption cause lean fatty liver disease?
It causes excessive influx, localized synthesis, and impaired clearance of fats in the liver cells.
- What kind of diet should I incorporate when dealing with lean fatty liver disease?
It is encouraged to incorporate a Mediterranean diet, which involves whole foods, unsaturated fats and avoiding highly industrialized foods.
