What is the treatment for MASH?

Metabolic dysfunction-associated steatohepatitis (MASH) is an advanced form of metabolic dysfunction-associated steatotic liver disease (MASLD). Formerly known as non-alcoholic fatty liver disease, MASLD occurs when there is a buildup of fats in the liver. This buildup is a result of metabolic dysfunction, problems with how the body converts nutrients into energy.

When a person has MASH, fat accumulation has reached the point where there is inflammation, damage to the liver, and at least some degree of fibrosis. Fibrosis occurs when repeated damage causes healthy liver tissue to be replaced with scar tissue. In its most severe stage, MASH causes cirrhosis, extensive scarring that has changed the structure and function of the liver. Cirrhosis can lead to liver failure and liver cancer.

Healthcare providers that treat MASH

If you or a loved one has been diagnosed with MASLD or MASH, it’s important to seek treatment. Treatment for liver disease is typically overseen by a hepatologist or a gastroenterologist:

• A hepatologist is a medical doctor that specializes in treating conditions that affect the liver, bile ducts, gallbladder and pancreas.
• A gastroenterologist is a medical doctor that specializes in treating conditions that affect the digestive system.

Other members of a healthcare team can include a primary care provider, endocrinologist, registered dietitian, and a weight loss specialist. People may need additional healthcare providers depending on coexisting or underlying conditions. For example, nephrologists (kidney doctors) and cardiologists, as kidney disease and cardiovascular disease often occur alongside MASH.

Medication therapy for MASH

There is one medication available for the treatment of MASH, which was approved in 2024. This medication is meant to be used alongside diet and exercise, which are important parts of any treatment plan for MASH.

This medication can help the progression of the disease and in some cases, improve fibrosis. It’s important to note that this treatment is approved for the treatment of MASH that has caused moderate-to-advanced fibrosis in the liver. It is not indicated for early-stage MASH or MASH that has resulted in cirrhosis.

Lifestyle interventions and coexisting conditions

An important focus of treating MASH is addressing the risk factors and coexisting conditions that contribute to the disease and its progression. This part of a treatment plan can include:

• Weight loss, typically with a goal of reducing body weight by 3 to 10 percent.
• Improving blood glucose control. This is often measured with A1C, a blood test that measures blood glucose levels over the past few months. A healthcare provider will help you establish an A1C goal and a plan for getting to goal.
• Building a diet around vegetables, fruits, whole grains, and lean proteins. Fatty foods, sugary foods, ultra-processed foods, and alcohol should be limited and avoided. A heart-healthy diet like the Mediterranean diet is a good example.
• Regular exercise, which helps support weight loss, cardiovascular health, and blood glucose control. This should include both aerobic exercise and muscle-strengthening exercises. A healthcare provider can guide you on how much exercise is recommended for your current health and fitness level, and good choices for exercise.
• This part of a treatment plan can also involve medications, such as medications for obesity, blood glucose control, blood pressure, and cholesterol.

These interventions will also help protect other parts of a person’s health, including cardiovascular health, kidney health, and lowering the risk of stroke.