MASH and Silent Liver Disease: Could Your Liver Be at Risk?

Fatty liver disease is now one of Australia’s most common and under-recognised metabolic health problems. Current Australian guidance describes metabolic dysfunction-associated fatty liver disease — often called MAFLD or MASLD — as affecting about 1 in 3 Australian adults. It is strongly linked with obesity, type 2 diabetes, insulin resistance, high blood pressure, abnormal cholesterol and increased waist circumference. (Australian Prescriber)

For many people, the more serious form — MASH, or metabolic dysfunction-associated steatohepatitis — develops silently. MASH means fat in the liver has progressed to inflammation and liver cell injury, which can lead to fibrosis, cirrhosis, liver cancer and liver failure. Importantly, liver blood tests can be normal even when clinically important fibrosis is present.

A new treatment option: semaglutide for MASH

In 2026, Australia’s Therapeutic Goods Administration provisionally approved a new medication for adults with non-cirrhotic MASH and moderate-to-advanced liver fibrosis, consistent with F2–F3 fibrosis. This is Australia’s first approved medication for this specific condition. (RACGP)

This does not mean medication is suitable for everyone with fatty liver. It means that, in carefully selected adults with confirmed MASH and significant fibrosis but not cirrhosis, medication may form part of treatment alongside nutrition, physical activity, weight management and cardiometabolic risk reduction. The approval is based on improvements in liver inflammation and fibrosis, with ongoing studies needed to confirm long-term clinical outcomes. (Australian Safety and Quality Commission)

The hidden burden of MASH

The challenge is that many people do not know they have liver disease. Fatty liver is common, symptoms are often absent, and abnormal liver enzymes are not a reliable screening tool on their own.

People at higher risk include those with:

• Type 2 diabetes or pre-diabetes

• Overweight or obesity

• Increased waist circumference

• High triglycerides or low HDL cholesterol

• High blood pressure

• Sleep apnoea

• PCOS

• A family history of metabolic or liver disease

Australian guidance emphasises that people with obesity, type 2 diabetes or other metabolic risk factors should be assessed for fatty liver disease and fibrosis risk. (Australian Prescriber)

How Perth Weight Clinic can assess your liver disease risk

At Perth Weight Clinic, we assess liver risk as part of a broader metabolic health review. This may include:

• A detailed medical and metabolic risk assessment

• Weight, BMI and waist circumference

• Blood tests including liver enzymes, platelets, HbA1c, lipids and other relevant markers

• Calculation of a FIB-4 score, a recommended first-line fibrosis risk tool

• Consideration of liver imaging or elastography, such as FibroScan, where appropriate

• Referral to hepatology when higher-risk features are identified

MASH can be treated — but first it must be found

The most important message is that MASH is not simply “fatty liver” to ignore. When diagnosed early, it can often be managed and treated through structured weight management, nutrition, physical activity, diabetes and cardiovascular risk optimisation, and — for eligible patients — medication options.

Perth Weight Clinic can help identify whether you are at risk, arrange appropriate investigations, and develop a personalised treatment plan focused not just on weight loss, but on improving long-term metabolic and liver health.

If you have weight-related health concerns, type 2 diabetes, prediabetes or abnormal liver tests, it may be time to assess your liver risk.