A former Miami Dolphins quarterback and Pro Football Hall of Famer, Dan Marino, has disclosed his diagnosis with metabolic dysfunction-associated steatohepatitis (MASH), a liver disease expected to become more prevalent in the coming decades. Marino shared his experience with People magazine, stating that he has managed the condition since 2007 through lifestyle changes aimed at reversing liver damage.
Lauren Dunn Gilbert, M.D., a gastroenterologist and hepatologist at the University of Miami Miller School of Medicine, commented on Marino’s public announcement: “Marino is bringing a lot of much-needed attention to the disease.” Dr. Gilbert anticipates increased vigilance among primary care providers regarding liver enzyme tests as awareness grows. She explained that this could lead to earlier detection of fatty liver disease, also known as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
Early diagnosis is crucial for halting or even reversing MASH progression. “Pause the progress of MASH and sometimes even reverse liver damage” can be achieved through diet, exercise, and weight loss, according to Dr. Gilbert.
MASH was previously referred to as nonalcoholic fatty liver disease and is marked by fat accumulation in the liver that can cause inflammation. If left untreated, it may result in cirrhosis or even liver cancer in advanced cases.
The main risk factors for developing MASH include Type 2 diabetes, high cholesterol and triglycerides, high blood pressure, obesity, family history of fatty liver disease, older age, and certain ethnic backgrounds such as Hispanic and Asian populations. Older adults are particularly vulnerable due to higher rates of related conditions like diabetes and hypertension; their livers are also less efficient with age and more susceptible to inflammation from medications.
Insulin resistance contributes significantly to the development of MASH among Hispanics and Asians. Obesity rates are notably high within these groups as well.
In 2020, an estimated 14.9 million adults in the United States were affected by MASH—nearly 6% of all adults. The number is projected to rise sharply alongside increases in Type 2 Diabetes cases and obesity rates. By 2050, researchers estimate that about 23.2 million Americans—or roughly 8% of the population—will have been diagnosed with MASH (source: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2839293).
Often called a “silent disease,” MASH typically presents no symptoms until significant liver damage occurs. There is currently no standardized screening test for this condition. “The disease can progress over decades without any symptoms,” Dr. Gilbert said. She noted that half her patients are referred after incidental findings during imaging for unrelated issues.
Because the liver does not produce pain signals, discomfort usually does not occur until later stages when complications such as jaundice, fatigue, abdominal pain, ascites (fluid buildup), swelling in lower extremities, varicose veins in the esophagus, or brain fog may appear.
Lifestyle modification remains central to treatment once MASH is diagnosed. “Lifestyle changes are the mainstay of treatment even before we prescribe,” Dr. Gilbert said. “Losing 10% of your weight can start to reverse damage to the liver.” She encourages moderate physical activity: “You don’t have to run a marathon. It can be as minimal as a 20- or 30-minute walk three to five times a week.”
Research supports these recommendations; recent studies have shown that dietary changes combined with physical activity improve outcomes for patients with MASH (source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829360). Another analysis published this year found that diet adjustments and regular exercise significantly improved liver enzymes while slowing fibrosis progression (source: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1421386/full).
Dr. Gilbert also highlighted new developments in treatment options—including investigational drugs targeting enzymes responsible for fat production—and pointed out that FDA approval of Wegovy provides another tool for supporting weight loss among patients with MASH.
“I tell my patients that there is reason to be optimistic,” she concluded.“If we can achieve adequate weight loss we can get patients back to a point of minimal to no fibrosis or stage 0-1.”
