What to Know About MASLD Plus a Liver-Friendly Recipe

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To help patients better understand how to protect their liver, The Educated Patient spoke with Kara Wegermann, M.D., a gastroenterologist and transplant hepatologist at Duke Liver Clinic. Wegermann explained the basics of metabolic dysfunction-associated steatotic liver disease (MASLD) — a term that replaces nonalcoholic fatty liver disease (NAFLD) and reflects the strong link between liver disease and metabolic conditions like obesity, diabetes and high cholesterol.

Alongside her medical insights, we’re sharing a liver-friendly Brown Rice and Salmon Bowl recipe, available through the American Liver Foundation (ALF), that’s rich in whole grains, vegetables and healthy fats. Together, these resources highlight how knowledge and nutrition can work hand in hand to support better liver health.

Brown Rice and Salmon Bowl

Ingredients

• ¼ cup olive oil
• 3 scallions, white and green parts separated and sliced thin
• 2 teaspoons grated fresh ginger, divided
• ⅓ cup distilled white vinegar
• Salt-free seasoning to taste
• 1 English cucumber
• 1 ¾ cups short-grain brown rice
• 1 pound carrots, peeled and sliced
• 1 pound shiitake mushrooms
• 1 (1-pound) salmon fillet
• 2 teaspoons hoisin sauce, divided
• 1 tablespoon sesame seeds, toasted
• Sriracha to taste

Instructions:

1. Preheat oven to 500 degrees. While you wait, heat 2 tablespoons oil in large saucepan over medium heat. Add scallion whites and 1½ teaspoons ginger and cook, stirring constantly, until fragrant. Transfer scallion mixture to a small bowl.
2. Bring 6 cups of water to boil in a saucepan. While water is coming to boil, whisk vinegar, ¾ teaspoon salt-free seasoning and remaining ½ teaspoon ginger in medium bowl. Add cucumber and stir until coated.
3. Add rice and 1 teaspoon salt to boiling water. Reduce heat and simmer until rice is tender, about 30 minutes. Drain rice well and return it to saucepan. Cover and set aside.
4. While rice is cooking, toss carrots with 1 tablespoon oil and ½ teaspoon salt-free seasoning. Spread in even layer on half of rimmed baking sheet. Toss mushrooms with 2 tablespoons water, remaining 1 tablespoon oil and remaining ½ teaspoon salt-free seasoning and spread in even layer on other half of sheet. Roast until vegetables are just beginning to soften and brown, about 10 minutes.
5. While vegetables are cooking, cut salmon in half. Halve each piece crosswise to create four equal pieces. Make two shallow slashes about 1 inch apart along skin side of each piece, being careful not to cut into flesh. Brush flesh side of each piece with ½ teaspoon hoisin.
6. Reduce oven temperature to 275 degrees and remove sheet. Push vegetables to either side to clear space in middle of sheet. Carefully place salmon, skin side down, in clearing. Return sheet to oven and roast until vegetables are tender and browned and centers of fillets are still translucent when checked with tip of paring knife and register 125 degrees (for medium rare), 10 to 12 minutes.
7. Measure out ¼ cup cucumber liquid and add to scallion mixture. Whisk in remaining 2 teaspoons hoisin. Stir 2 tablespoons dressing into rice.
8. Spoon rice into four wide bowls. Place 1 piece of salmon on top of rice. Arrange carrots, mushrooms and cucumbers in piles that cover rice. Drizzle salmon and vegetables with remaining dressing. Sprinkle with sesame seeds and scallion greens. Serve, passing sriracha separately, if using.

For patients who may not have heard the term before, what is MASLD and how is it different from the older term NAFLD?

Kara Wegermann, M.D.: MASLD is metabolic dysfunction-associated steatotic liver disease. It means that we see abnormal fat accumulation in the liver and that you have at least one metabolic risk factor (overweight or obesity, diabetes, high blood pressure or high cholesterol). The old definition, nonalcoholic fatty liver disease (NAFLD), was defined by an absence of harmful alcohol use. We now recognize that many patients with MASLD also use alcohol and there is a spectrum of disease.

What are the main causes and risk factors for developing MASLD?

KW: The main risk factors for developing MASLD include being overweight or obese (being severely overweight) and having diabetes, high cholesterol or high blood pressure, which are all conditions associated with MASLD.

Are there early signs or symptoms that people should watch for, or is it often silent until more advanced stages?

KW: Generally, people don’t have symptoms. However, your primary doctor may be checking your liver numbers with your routine bloodwork, and if these are abnormal, you may need additional testing such as an ultrasound of the liver. MASLD can cause inflammation and scarring (called fibrosis) in the liver, which over decades can lead to the liver not doing its day-to-day jobs as well as it should. So it is a condition that should be monitored. We can estimate how much scarring is in the liver using a routine bloodwork. When the bloodwork hints at more scarring, we do additional tests to confirm.

Who should be screened for MASLD — should everyone at risk get checked, or only people with certain conditions like Type 2 diabetes or obesity?

KW: Right now, it isn’t recommended that the general public be screened for MASLD, or even patients with specific risk factors. There is a lot of debate about this in our field, though. It is estimated that two-thirds of individuals with diabetes have MASLD, so they are considered high risk.

What lifestyle changes have the biggest impact on improving MASLD?

KW: Weight loss of 5% in men and 10% in women affects the amount of fat and inflammation in the liver. For many patients, that’s 10 to 20 pounds. We recommend working toward that goal by following a Mediterranean diet (limit processed foods and focus on lean proteins like chicken, fish and beans, eat plenty of vegetables and fruits, and choose whole grains) and exercising 30 minutes per day, 5 days per week.

What role do patient education and self-monitoring play in managing MASLD?

KW: A huge role. Although a liver specialist plays an important role in monitoring the condition, we generally only see patients once or twice a year, depending on their situation. It is your day-to-day routine of diet and exercise managed by the patient, along with help sometimes from dietitians, physical therapists, personal trainers or other providers.

What’s one thing you wish every patient understood about MASLD?

KW: Making changes can be overwhelming, but you don’t have to do it all at once. I tell patients to start with one change in their diet. For example, replace your afternoon soda with sparkling water. For exercise, start with 10 minutes a day. Walk up and down your driveway a few times. Then, try to do 12 minutes. Working up gradually can make it feel less like you need to overhaul all of your routines at the same time. Very recently, semaglutide was approved for patients with MASLD and fibrosis, so ask your doctor if you qualify. We are hoping to see more medication options in the coming months and years.