Metabolic dysfunction-associated steatohepatitis (MASH) is the excessive build-up of lipid cells in the liver associated with metabolic dysfunction but not necessarily caused by alcohol. It is the most common cause of chronic hepatic disease and affects about 30% of the adult population worldwide. Reports also have it that the prevalence has risen from 22% to 37% since 1991. In a hospital review, the majority of cases admitted to the ward for cirrhosis had metabolic dysfunction-associated liver disease (MALD), which is a milder form of MASH.
MASH was formerly called non-alcoholic steatohepatitis (NASH) but scientists felt like it didn’t place much emphasis on the effects of metabolic factors, so they modified the name. MASH constitutes the accumulation of lipid molecules like fatty acids, cholesterol, ceramide, and diacylglycerols. These molecules are toxic to the liver tissue and cause the destruction of intracellular organelles and disruption of cell signaling.
Because metabolic dysfunction is strongly related to MASH, obesity, diabetes, and dyslipidemia are strong risk factors for the disease. Others are hypertension, unhealthy diet, smoking, and a positive family history of metabolic conditions. Patients come down with signs of liver failure which include fever, jaundice, malaise, and right upper quadrant abdominal pain and discomfort. As MASH progresses, it can lead to hepatic cirrhosis, hepatic failure, or even hepatocellular carcinoma (HCC).
Effect of MASH and NASH on death
Table of Contents
MASH and NASH were differentiated because of the metabolic links found in MASH, however, when they present with similar clinical features, it is usually hard to distinguish them from each other. In MASH, there’s usually at least one of the metabolic factors without the influence of alcohol or hepatitis. So, generally considering the comorbid conditions, MASH is highly likely to increase the risk of dying.
A study that was carried out over a 15-year period reported that NASH was not linked to an increased death rate, compared to MASH. NASH can also lead to hepatic cirrhosis and HCC but researchers are of the opinion that MASH is more fatal.
MASH causes an increase in the death rate
Recently, a prospective study that utilized data from the entire US population via NHANES III (1988-1994) was carried out to confirm the death rates associated with MASH and NASH. After using a follow-up period of 27 years, the researchers discovered that NASH was not associated with an increase in death rate compared to MASH which had an increased risk of 53%.
They found out that even in the absence of metabolic factors, advanced hepatic fibrosis and scarring lead to an increase in the death rate in cases of MASH. This shows that MASH is more fatal and causes more death than NASH. Furthermore, NASH only increased death risk when they considered traditional and demographic but not metabolic factors.
Clinical Significance
These findings give us an insight into the link between MASH, NASH, and lifetime mortality. Apparently, to the best of our knowledge, no study has been carried out to discover the relationship between MASH and death rate.
During the study, they created various models for data analysis that led to the discovery that MASH still increased the risk of dying even in the absence of metabolic factors. This suggests that alcohol consumption could be a significant risk factor in this situation.
References
Li, Z., Song, R., Zhang, Y., Tan, J., & Chen, Z. (2024). Metabolic dysfunction-associated steatohepatitis is associated with increased all-cause mortality [Preprint]. bioRxiv. https://doi.org/10.1101/2024.06.28.24309687
FEEDBACK:
