Diabetes and obesity can damage the liver to the point of failure – but few people know their risk of developing liver disease

Insulin resistance links MASLD to several other metabolic diseases. Kateryna Kon/Science Photo Library via Getty Images by Madona Azar, UMass Chan Medical School Liver disease is frighteningly common worldwide. Metabolic dysfunction-associated steatotic liver disease, or MASLD, is an umbrella term describing conditions related to a buildup of fat in the liver. Formerly known as nonalcoholic fatty liver disease, this condition affects 1 in 4 people worldwide. Among those with type 2 diabetes, insulin resistance, obesity or all three, the prevalence of MASLD increases to 3 in 4 people. As a diabetologist, the possibility of liver disease is on my mind every time I see a patient. Understanding your risk of developing this common yet underrecognized condition is essential to treating it. What is MASLD? MASLD is a complex disorder with both environmental and genetic contributions. In its early stages, liver cells accumulate fat in a process called steatosis. Major sources of this fat include adipose tissue as well as fatty acids the liver makes in response to insulin resistance and excess caloric intake. This fat accumulation can enlarge the liver and interfere with its normal functioning. Over time, fatty acids activate enzymes, which can produce toxic byproducts capable of causing...