WHAT IS MASH, NASH, MASLD OR MAFLD
Recently, one of our community leaders passed away. She was a vegetarian, teetotaler and religious with no addictive habits. It was a surprise for many of us. When asked around, we were told that she had MASH – an abbreviation for a disorder of the liver where fat gets deposited in the liver, otherwise called as fatty liver, that leads to eventual cirrhosis of liver, liver failure and death. Medical books are full of abbreviations and acronyms and doctors love to show off their flair.
The full name for MASH is Metabolic Dysfunction Associated Steato-Hepatitis. There are other abbreviations for the same pathology. NASH means Non-Alcoholic Steato- Hepatitis. MASLD means Metabolic Dysfunction Associated Steatotic Liver Diseases and MAFLD means Metabolic Dysfunction Associated Fatty Liver Disease. During our college days, they were simply referred to as ‘fatty liver.’
What happens to the liver in this condition? Fat accumulates in the liver initially. This leads to inflammation of liver cells and progresses to scar tissue formation and cirrhosis of liver. When it gets worse, it can cause liver failure, jaundice and general weakening of the body leading to death. Besides cirrhosis, one can also develop hepatocellular cancer of the liver.
How does the fat come to the liver? There are three sources. First, the liver converts excess sugar or glucose in the body to fat for storage. Second, there is fat coming from diet, especially excessive amounts of saturated fats, trans fats and ultra-processed foods. Finally, it transfers excessive adipose tissue from other parts of the body to the liver.
Different metabolic problems can cause excess fat accumulation. Some such conditions are diabetes mellitus, obesity, insulin resistance, hypertension, elevated triglycerides and low level of HDL cholesterol. Diets with excess calorie intake or consumption of saturated fats, sugar and carbohydrates are also risk factors. A sedentary lifestyle with lack of physical activities exacerbates insulin resistance and obesity. Insulin resistance in Type 2 diabetes causes visceral fat accumulation and inflammation.
Statistics show that four out of 10 Americans are prone to have fatty liver. Latinos are at a higher risk due to a genetic variant. Many Indians are vegetarians but fond of consuming excess of carbohydrates and sweets made from saturated fats such as margarine, butter, shortening or ghee. Ultra-processed food items such as snacks, ice cream and cakes are culprits too.
Symptoms are mild in the early stages. Fatigue and general weakness with varying degrees of upper abdominal pain and discomfort are noted. An enlarged liver may be palpable under the right rib cage. When advanced, they develop jaundice, ascites (fluid accumulation in the abdomen), confusion due to hepatic encephalopathy, or upper gastrointestinal bleeding.
Tests to confirm the diagnosis start with physical examination and detailed history taking. Blood tests to measure liver functions, blood sugar, blood cell counts and kidney functions are relevant. As liver failure and cirrhosis worsens, the person can develop anemia and clotting failures. Further tests include ultrasound of the abdomen, CAT scan or MRI. A more confirmative test is a needle biopsy of the liver. Fibrosis risk scores are assessed to understand the severity of scar formation.
Pathological findings are specific on biopsy of the liver. Steatosis is an excess lipid accumulation in the hepatocytes. The hepatocytes are found to be ballooned. Inflammatory cells are discovered infiltrating in liver parenchyma. Damaged keratin filaments are called Mallory Denk bodies. Megamitochondria are seen due to metabolic stress as well fibrosis and scarring.
What can we do about it? The first step is, of course, prevention. Diet has a significant role. Mediterranean diet with whole grain, legumes, vegetables, nuts and fruits is recommended. Control of visceral fat is important. Balanced diet with moderation of refined carbohydrates, moderation of fats, adequate proteins and vitamins is best. Alcohol consumption is to be totally avoided. Fatty liver can happen without eating fats in food. Biggest culprits are excess calories, too much sugar, ultra-processed food (UPF), trans fats, refined carbohydrates and insulin resistance. Fats with Omega 3 fatty acids such as olive oil and fish oil are good.
Besides measuring BMI, one is advised to measure abdominal girth in managing obesity. Waist girth above 45 inches for men and 35 inches for women is considered as obesity. Another measure is waist to hip ratio to be kept at 1 or below. Excess abdominal girth is due to visceral fat, which can move to the liver. Regular exercise is a useful step in prevention. Any type of exercise for 30 minutes a day would be adequate. Routine physical examination and blood tests for liver function and lipid profile are helpful to find early onset of the metabolic disorders.
Management of diabetes mellitus and obesity with the new generation of drugs called GLP-1s are useful for MASH as well. Insulin sensitizers such as Pioglitazone are useful in reducing fatty liver and scar formation in patients with insulin resistant diabetes mellitus. Vitamin E is found helpful, particularly in non-diabetics.
A new drug that has been found effective specifically for fatty liver is “resmetirom.” It is a selective thyroid hormone receptor beta agonist that increases fat metabolism, reduces fat accumulation in the liver, lowers inflammation, scarring and fibrosis in the liver. In addition, it lowers triglycerides and LDL cholesterol, thus helping heart problems too. The drug is specific to MASH and is taken as a once-a-day oral pill. Initial results show excellent results in treating fatty liver.
Surgical procedures to reduce obesity include bariatric surgery for weight reduction. Laparoscopic sleeve gastrectomy with robotic assistance appears to be the procedure of choice currently. Eventually, one may have to consider liver transplantation for advanced cirrhosis.
Many people of Indian origin are vegetarians and consider themselves to be on a good diet. Unfortunately, a vegetarian regime does not automatically mean healthy diet. Vegetarians are also prone to develop metabolic problems. A balanced diet is recommended for all.EYE CARE
Seeing Clearly: A Focus on Women’s Eye Health
April is Women’s Eye Health and Safety Awareness Month
By Dr. ARUN GULANI
When we think of health and wellness, our vision may not always come to mind first — but it should. Our eyes are our connection to the world, to the people we love, and to the moments we cherish. And yet, studies show that women are disproportionately affected by eye disease and vision loss. In fact, women make up nearly two-thirds of all blindness and visual impairment cases globally.
That’s why April is designated as Women’s Eye Health and Safety Awareness Month — to raise awareness, empower choices, and encourage proactive care. As an eye surgeon with over three decades of experience with the privilege of treating patients from across the globe, I’ve witnessed firsthand the impact that early intervention, education and personalized care can have on preserving and restoring vision.
Understanding the Risks Women Face
Why are women more affected? The reasons are both biological and social.
- Hormonal changes: Throughout life stages — from puberty to pregnancy to menopause — fluctuating hormone levels can affect the eyes. These changes can lead to dry eye syndrome, blurred vision or changes in prescription.
- Autoimmune disorders: Women are more likely than men to suffer from autoimmune diseases such as lupus, rheumatoid arthritis and Sjögren’s syndrome — many of which can involve the eyes and lead to chronic discomfort or damage.
- Longer life expectancy: Women generally live longer, and age is a significant risk factor for conditions like cataracts, macular degeneration and glaucoma.
- Lifestyle and occupational exposure: Increased use of cosmetics, digital screen exposure, and even certain beauty procedures around the eyes can increase risk when safety is overlooked.
- Access to care: Caregiving roles and cultural expectations can sometimes cause women to delay their own health appointments — including eye exams.
What You Can Do to Protect Your Vision
Fortunately, there is a great deal we can do to prevent vision loss and maintain eye health throughout life. Prevention, awareness and consistency are key.
1. Schedule regular eye exams
Annual comprehensive eye exams are crucial — even if you don’t wear glasses or contacts. Many sight-threatening diseases, like glaucoma or macular degeneration, begin with no noticeable symptoms.
2. Share your family history
Inform your eye doctor of any family history of eye disease. Conditions like glaucoma and retinal disorders can be hereditary and should be monitored closely.
3. Be mindful of dry eyes
Women are more prone to dry eye syndrome, especially during pregnancy or menopause. Symptoms include itching, burning or the sensation of something in the eye. Don’t ignore them — modern treatments can offer relief.
4. Protect against UV exposure
Wear sunglasses that block 100 percent of UVA and UVB rays, even on cloudy days. UV exposure increases the risk of cataracts and macular degeneration over time.
5. Practice makeup and lens hygiene
Always remove eye makeup thoroughly before bed. If you wear contact lenses, follow hygiene instructions meticulously. Never share cosmetics and replace eye products regularly.
6. Nourish your vision
A balanced diet rich in leafy greens, omega-3 fatty acids, citrus fruits and antioxidants supports healthy eyes. Don’t underestimate the power of nutrition in eye care.
7. Stay alert to changes
Blurry vision, floaters, flashes of light, or loss of side vision can all signal a more serious issue. Don’t wait to see if it passes — schedule an exam promptly.
Empowering Women to Prioritize Their Vision
In my years of caring for patients — from young mothers balancing careers and caregiving, to seniors who’ve quietly adapted to progressive vision loss — I’ve seen how deeply sight impacts quality of life. I’ve also seen how modern eye care can reverse years of compromise, when given the chance.
One of the most powerful things a woman can do for herself, and her family is to prioritize her own vision. Clear sight allows for independence, confidence and safety. It enables everything from driving and reading to recognizing faces and enjoying nature’s beauty.
Please remember as I have mentioned in my previous articles, if you have been diagnosed with cataracts there is no need to wait, if you have had bad outcomes of Lasik or radial keratotomy surgery or told that you're not a candidate due to keratoconus, thin cornea or high astigmatism, you can be helped and you must seek out the best vision corrective surgical option for yourself period