Mind & Body

The Liver Disease That’s on the Rise

Here’s why it matters for people with bleeding disorders.
Author: Beth Levine
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Updated

Have you heard of metabolic dysfunction-associated steatotic liver disease, or MASLD?

The term refers to a rising disease in which fat accumulates in the liver, causing it to enlarge and become impaired. While some fat is normally present in the liver, if fat makes up more than 5% to 10% of the liver’s weight, that meets the criteria for MASLD. (This disease used to be called nonalcoholic fatty liver disease.)

It’s important for everyone to have a healthy liver, and that’s especially true for people with hemophilia and other inheritable blood and bleeding disorders, because in addition to serving other functions such as digesting food, removing toxins, and storing energy, the liver plays a crucial role in the body’s ability to regulate blood clotting.

Rising Rates of MASLD

A 2023 study conducted by researchers at the Charles R. Drew University of Medicine and Science in Los Angeles revealed that MASLD in Americans increased 131% during the past three decades, rising from 16% in 1988 to 37% in 2018.

A Taiwanese study in Clinical and Applied Thrombosis/Hemostasis found a high prevalence of MASLD in people with hemophilia. This is important, researchers say, because “liver health is essential for persons with hemophilia (PWH) in order to maintain access to new therapies, such as gene therapy.”

In addition, untreated MASLD can lead to cirrhosis, liver cancer, and even liver failure.

What Causes MASLD?

Bruce Luxon, M.D., Ph.D., chair of the Department of Medicine at Georgetown University Medical Center in Washington, D.C., and a member of the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council, says the main risk factors for developing complicated MASLD are:

  • High body mass index (BMI)
  • High blood pressure
  • Elevated serum glucose
  • High triglycerides and low LDL cholesterol
  • Smoking
  • Having or being at risk for cardiometabolic disorders, a cluster of diseases that includes cardiovascular disease, metabolic syndrome, and diabetes.

The Connection to Hemophilia

Experts aren’t exactly sure what is driving the increase in MASLD in people with hemophilia, but one hypothesis, according to the Taiwanese study, is being overweight or obese. While rates of obesity have increased in the general population due to the pandemic, “people who have hemophilia often have limited joint mobility, so their ability to exercise and maintain reasonable weight is more difficult,” Luxon says.

He urges people with hemophilia who are at risk for MASLD to stay positive. “Medical science is trying to find a pharmacologic treatment that would help minimize liver damage. It’ll be a slow process as we figure out how to use these pharmacologic agents, but I think we will have that in a couple of years,” Luxon says.

Protect Your Liver

Luxonoffers advice on how you can reduce your risk of developing MASLD:

  • If you have a cardiometabolic disorder (cardiovascular disease, metabolic syndrome, or diabetes), make sure it’s being treated and well managed by your provider.
  • Maintain a healthy BMI. If you have trouble exercising, ask your doctor or physical therapist to help you develop a safe routine.
  • Eat a healthy diet. Your menu should be primarily plant-based, and you should avoid processed and fatty foods.
  • Reduce alcohol intake.
  • Quit smoking.
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