30-31 CONDITIONS - Wake-up call

Metabolic dysfunction-associated steatotic liver disease, formerly known as non-alcoholic fatty liver disease and often referred to as fatty liver disease, affects nearly 30% of adults worldwide.

It is one of the most prevalent chronic liver conditions, yet despite its scale it is still too often misdiagnosed, misunderstood or mistreated, delaying meaningful intervention for millions.

For decades, MASLD has been described as a ‘silent’ condition because it rarely presents with dramatic liver specific symptoms early on. Instead, it hides in plain sight, embedded within metabolic dysfunction and everyday complaints that are easy to attribute elsewhere.

However, growing evidence shows this narrative is incomplete and often misleading. If you sit down with a patient navigating MASLD and listen closely, you will not hear silence.

You will hear fatigue that feels like a lead weight, abdominal pain, sleep issues, bloating that adds to physical discomfort and brain fog that turns a simple workday into climbing Everest.

You will also hear about depression symptoms; anxiety and the looming risks tied to metabolic dysfunction. These symptoms are real and disruptive to daily life, yet they are commonly attributed to stress, ageing or comorbid conditions rather than recognised as part of a broader metabolic picture.

From a clinical perspective, this presents a real challenge. Liver enzymes may be only mildly elevated or even normal. Imaging may be incidental. Patients may appear ‘asymptomatic’ on paper while struggling to function day to day.

For healthcare professionals, particularly pharmacists who are often the most accessible point of care, this creates both an opportunity and a responsibility to help connect the dots between prescriptions, supplements and patient-reported fatigue, nudging the conversation towards meaningful evaluation.

MASLD is not a liver-only condition. It is a systemic manifestation of metabolic dysfunction. The liver, under stress, releases cytokines and other pro-inflammatory mediators that circulate throughout the body, affect the brain and disrupt energy regulation systems.

Insulin resistance that drives MASLD starves cells of glucose and leaves patients feeling exhausted despite adequate rest. When clinicians dismiss this as ‘normal ageing’, ‘stress’ or ‘just part of life’, patients stop mentioning it.

Validating this symptom changes the dynamic of the consultation and gives the patients a reason to care about their liver health that is immediate and tangible.
So how can the healthcare community strengthen the way MASLD is identified and managed?

First, reframe the conversation. Rather than waiting for advanced liver disease, we must recognise MASLD as part of a metabolic continuum that intersects with diabetes, obesity, cardiovascular risk and lifestyle factors.

Asking simple, targeted questions about energy levels, sleep quality and daily functioning can surface early warning signs.

By validating symptoms, we change the dynamic of the consultation and give the patients a reason to care about their liver health that is immediate and tangible.
Second, use the tools already available. Non-invasive assessments, including elastography and Controlled Attenuation Parameter scores, now let clinicians visualise steatosis and fibrosis accurately.

These tools shift conversations from abstract risk to tangible realities and create space to ask the questions that matter: ‘How are your energy levels?’, ‘Do you wake feeling well rested?’ or ‘How is this affecting your work and family life?’

What patients report matters just as much as what tests reveal.

Third, empower patients through self-care. Improving health outcomes starts with giving people the knowledge and tools to act earlier. MASLD management is not limited to specialist settings. It includes lifestyle interventions, metabolic health support and long-term engagement that often begins in the community pharmacy.

When patients understand how their daily choices affect liver and metabolic health, self-care becomes a powerful complement to clinical care.

Finally, recognise the role of pharmacists. Pharmacists are uniquely positioned to identify patterns such as repeated complaints of fatigue; sleep aids used alongside metabolic medications or conversations that reveal declining quality of life.

These touchpoints can prompt timely referrals, reinforce adherence and help patients navigate what is often a confusing diagnosis.

MASLD is not silent. It has been speaking all along, and the challenge ahead is accurate identification and appropriate treatment.

By listening more closely, asking better questions and empowering patients to engage in their own care, we can change the trajectory of a condition that affects nearly one in three adults worldwide. Silence ends where action begins.

MASLD is now the leading cause of chronic liver disease globally, surpassing many traditional liver conditions
The condition develops quietly over years, often beginning long before any liver-related symptoms appear
MASLD is strongly linked to insulin resistance, which means many people with type 2 diabetes also have underlying liver fat
Even people at a healthy weight can develop MASLD if they have metabolic risk factors like high blood pressure or elevated blood sugar
MASLD increases the risk of cardiovascular disease, which is the leading cause of death in people with the condition
The liver can regenerate, meaning early MASLD can often be improved or reversed with timely lifestyle changes
Sleep disturbances are common in MASLD due to the metabolic and inflammatory changes affecting energy regulation
MASLD can progress to metabolic dysfunction–associated steatohepatitis, a more severe form involving liver inflammation and scarring
Many people discover MASLD only after an unrelated scan, highlighting the importance of routine metabolic health checks
Community pharmacists are increasingly recognised as key players in early MASLD detection because they regularly hear about symptoms like fatigue, low mood and poor sleep.