I’m going to tell you about a deadly and common liver disease. The disease affects one in three American adults. It is the leading cause of cirrhosis (a term for a family of end-stage liver diseases). It is also the #1 reason people need lifesaving liver transplants.

The disease is not alcoholic liver disease . Nor is it liver cancer , or any kind of viral hepatitis . And even though you probably haven’t heard of this disease, it is more common than all those other diseases. Combined!

Have you guessed its name yet? And have you figured out whether you are at risk for it?

The disease is metabolic dysfunction-associated steatotic liver disease, otherwise known as MASLD (pronounced ‘mazzel-D’). And it is silently destroying millions of people’s livers without their, or their doctors’, knowledge.

Let me unpack the term before telling you a bit more about how common and dangerous this illness is, as well as some promising ways to manage it.

The word “metabolic” is important. It places MASLD within a family of other disorders that typically combine overweight and obesity with high blood pressure, high cholesterol, and diabetes. Most people understand that gaining weight can cause or aggravate these other disorders. But they do not realize that, even before they develop high blood pressure or diabetes, they are probably experiencing liver damage. In fact, MASLD affects about 75% of people with obesity.

Over time, obesity causes fatty buildup in the liver, a phenomenon captured by the word “steatosis.” For reasons not completely understood, fatty buildup leads to chronic inflammation and oxidative stress . Over the course of 20 to 30 years, this stress overwhelms the liver, the damage coming faster than the organ’s attempts at self-repair.

Over those decades, people typically don’t have symptoms of liver disease. Indeed, when symptoms of liver damage arise, it usually means the illness is quite advanced.

If only someone had intervened earlier!

That’s where the good news is. If you’re chronically obese, ask your doctor to check on the health of your liver. If they find signs of MASLD, they can help you address your underlying metabolism. They can probably even prescribe a drug like Wegovy, which has been approved to treat MASLD. That also means insurers ought to pay for it, even if you don’t yet have diabetes.

Some more good news. You do not need access to liver specialist to diagnose and treat the condition. Primary care physicians are well trained to address metabolic disorders. But that doesn’t mean they’re keeping this diagnosis at the top of mind. Awareness of the condition still lags behind its severity.

Do not be shy. If you have type II diabetes or obesity, ask your doctor to check you for MASLD. Don’t wait to be stalked down by this silent killer.