Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease, is on the rise globally, affecting an estimated 1.8 billion people by 2050 if lifestyle changes are not adopted. Experts warn that this condition, often silent and asymptomatic for years, is increasingly diagnosed in individuals who consume little to no alcohol. It is driven by factors such as obesity, type 2 diabetes, high blood pressure, and unhealthy diets.
MASLD is characterized by fat buildup in the liver, which can lead to inflammation, scarring, cirrhosis, liver failure, and liver cancer. It is also considered a manifestation of metabolic syndrome, a cluster of conditions that increase the risk of heart attacks and strokes. In the UK, fatty liver disease is the only major disease for which death rates are still rising, accounting for approximately 12,000 deaths annually.
Ultra-processed foods (UPFs) are identified as a primary culprit. These foods, often containing artificial sweeteners, flavors, and emulsifiers, can disrupt hormones and accelerate disease progression. Their ease of consumption leads to excess fat storage, with the liver being one of the first organs affected. Studies indicate that the average person consumes 56% of their daily calories from UPFs, significantly increasing the risk of fatty liver disease.
Sugary drinks, including both full-fat and diet varieties, also pose a considerable risk. Research analyzing the diets of over 123,000 British adults found that high consumption of sugar-sweetened beverages increased the likelihood of developing MASLD by 50%. Even low or non-sugar-sweetened drinks like diet soda were associated with a 60% increased risk. Experts suggest that artificial sweeteners, which the liver cannot readily process, contribute to inflammation and fat accumulation.
Non-fizzy drinks such as fruit juices and smoothies can also be detrimental due to their high fructose content, which the liver metabolizes. Excessive fructose intake can strain the liver and trigger inflammation. Similarly, processed meats, including sausages, bacon, and ham, are linked to higher risks due to additives and preservatives like nitrates, which the liver struggles to process. While moderate consumption of red meat is generally considered safe, processed meats are often high in salt and saturated fat, contributing to inflammation and high blood pressure.
Alcohol, while a known toxin to the liver, is not the sole cause of liver disease, with 70% of cases unrelated to alcohol. However, the type of alcohol and mixers used can influence its impact. Cheap spirits mixed with artificially sweetened or sugar-laden beverages can expose the liver to multiple toxins simultaneously. Experts advise that binge drinking, especially when combined with substances like paracetamol, is particularly dangerous.
Conversely, certain dietary patterns and foods may offer protective benefits. A Mediterranean-style diet, rich in vitamin C, fiber, healthy fats, and antioxidants, can help reduce liver fat and inflammation. Ingredients like extra virgin olive oil, fish, whole grains, and vegetables are beneficial. Coffee consumption has also been linked to a reduced risk of liver cancer and death from liver disease. Studies suggest that drinking five or more cups of coffee daily could lower the risk of liver cancer by 50%. The anti-inflammatory properties and compounds in coffee are believed to prevent and reduce scar tissue formation in the liver.
Individuals at higher risk for liver disease include those with obesity, type 2 diabetes, and high blood pressure. People from lower socioeconomic backgrounds may be disproportionately affected due to the greater availability of UPFs. Genetics also plays a role, contributing to cases of fatty liver in individuals who are not overweight.
IMAGE2: Liver disease is the only major disease for which UK death rates are escalating. Cases of metabolic dysfunction-associated steatotic liver disease have increased by 143 per cent over the last three decades
Siggi Clavien, founder of The Liver Clinic, noted that approximately 80% of individuals with fatty liver disease remain undiagnosed. Despite its silent progression, the liver is a resilient organ capable of over 500 bodily functions when given the chance to heal through improved diet and lifestyle choices.