The “Silent” Liver Condition That May Affect More Than the Liver

MASLD can exist without obvious symptoms. Growing evidence shows that its significance may extend beyond the liver, particularly when cardiovascular, kidney and metabolic health are considered together.

Fat accumulation in the liver can occur without symptoms. This is one reason metabolic dysfunction-associated steatotic liver disease (MASLD) may remain unnoticed for a long time.

MASLD is closely linked with metabolic health and is associated with cardiovascular disease and chronic kidney disease. This has led researchers to look more closely at the connections between the liver, heart, kidneys and metabolic system.^1,2

This does not mean that liver fat directly causes heart or kidney disease in every person with MASLD. Many of the same factors including insulin resistance, high blood pressure, abnormal blood lipids and type 2 diabetes can affect several organs at the same time.^1,2

What is MASLD?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition in which excess fat accumulates in the liver in association with at least one cardiometabolic risk factor, after other important causes of liver fat accumulation have been considered.¹

Cardiometabolic risk factors include conditions such as:

• type 2 diabetes or abnormal blood sugar regulation
• high blood pressure
• abnormal cholesterol or triglyceride levels
• excess body fat, particularly when accompanied by other metabolic risk factors

The term MASLD replaced the older term non-alcoholic fatty liver disease (NAFLD) to use terminology that better reflects the metabolic factors associated with the condition.³ MASLD is also a spectrum. Some people have liver fat without significant injury, while others develop inflammation and progressive fibrosis, meaning the formation of scar tissue in the liver. Advanced fibrosis can eventually lead to cirrhosis. ¹

Why can MASLD go unnoticed?

The liver can accumulate fat without producing noticeable symptoms. Some people may have no liver-related symptoms even when fat accumulation is present. Liver enzymes in a routine blood test may also be normal in some people with clinically important liver disease.¹

The absence of symptoms does not necessarily indicate the absence of liver disease. MASLD may instead be discovered during an abdominal ultrasound, blood tests, or evaluation of another metabolic condition.

Why does the heart come into the picture?

Cardiovascular disease is an important health concern in people with MASLD. The liver, blood vessels and metabolic system are affected by several overlapping processes. These include insulin resistance, abnormal handling of fats and glucose, inflammation and changes in vascular function. These processes can occur across several organs rather than remaining confined to the liver. ^1,2

Research has therefore found an association between MASLD and cardiovascular disease. MASLD does not mean that cardiovascular disease will inevitably develop. It also does not prove that liver fat itself is the direct cause of a heart attack, stroke or other cardiovascular event.

Shared metabolic risk factors play an important role.

This is one reason current guidance recommends that cardiovascular risk factors and associated metabolic conditions are assessed when MASLD is identified. ¹

What about the kidneys?

Studies have found an association between MASLD and an increased risk of chronic kidney disease, particularly when significant liver fibrosis and metabolic risk factors are present.^1,2

Diabetes, high blood pressure, obesity, insulin resistance and other metabolic abnormalities can increase the risk of both MASLD and CKD (Chronic Kidney Disease). These shared factors make it difficult to separate the effects of liver disease from the effects of the wider metabolic environment.¹

Fibrosis may matter more than liver fat alone

Finding fat in the liver does not show how much liver damage has occurred. Fibrosis means that scar tissue has developed in the liver following ongoing injury. The degree of fibrosis is an important marker of long-term risk in MASLD. ^1,2

A liver may contain a substantial amount of fat without having advanced fibrosis. Conversely, a person with less obvious liver fat may still have clinically important liver fibrosis. Therefore, current guidelines recommend risk assessment for liver fibrosis in people with MASLD and relevant metabolic risk factors. Non-invasive tools can be used to estimate fibrosis risk before more specialised testing is considered.¹

Why are researchers talking about the liver, heart and kidneys together?

Traditionally, metabolic conditions have often been considered one organ system at a time.

• Diabetes may be managed as a blood-sugar problem.
• Hypertension as a blood-pressure problem.
• Kidney disease as a kidney problem.
• Liver fat as a liver problem.

But these conditions frequently overlap. The same underlying metabolic disturbances can affect multiple organs. Disease in one organ may influence processes in another. This has led to growing interest in broader frameworks that consider cardiovascular, kidney, liver and metabolic health together. A 2026 review specifically examined how the liver could be incorporated into the cardiovascular-kidney-metabolic framework.²

The terminology and clinical framework are still developing, so this should not be interpreted as a new diagnosis that replaces established conditions.

What is usually assessed when MASLD is identified?

Assessment depends on the individual, but may include:

• blood glucose or HbA1c
• blood pressure
• cholesterol and triglyceride levels
• kidney function
• cardiovascular risk factors
• liver enzymes
• assessment of liver fibrosis using non-invasive tests when appropriate

The aim is to understand the overall health picture and identify factors that may increase the risk of liver, cardiovascular or kidney complications.¹

What does this mean for people with MASLD?

A diagnosis of MASLD does not automatically mean that serious liver, heart or kidney disease is present. It does mean that the finding deserves to be considered in the context of overall metabolic health.

Lifestyle measures including regular physical activity, a healthy dietary pattern and appropriate weight management form an important part of MASLD management. Associated conditions such as diabetes, high blood pressure and abnormal blood lipids also need appropriate management.¹

Conclusion

MASLD may begin with fat accumulation in the liver, but its significance can extend beyond the liver. The current evidence points towards an interconnected picture involving metabolism, the liver, cardiovascular system and kidneys.

The important point is that liver fat can be a marker of broader metabolic dysfunction. That shift from treating the liver as an isolated organ to understanding its place within the body’s metabolic network is an important development in current research.

References

1. Tacke F, Horn P, Wai-Sun Wong V, Ratziu V, Bugianesi E, Francque S, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology [Internet]. 2024 [cited 2026 Sept 21]; 81(3):492–542. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168827824003295.
2. Marshall W, Sinha S, Green D, Kalra P. INTEGRATING THE LIVER INTO THE CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME: PATHOPHYSIOLOGY AND THERAPEUTIC IMPLICATIONS. Current Opinion in Nephrology & Hypertension [Internet]. Lippincott Williams & Wilkins; 2026 [cited 2026 Sept 21]. Available from: https://research.manchester.ac.uk/en/publications/integrating-the-liver-into-the-cardiovascular-kidney-metabolic-sy/.
3. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology [Internet]. 2023 [cited 2026 Sept 21]; 79(6):1542–56. Available from: https://linkinghub.elsevier.com/retrieve/pii/S016882782300418X.

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