Metabolic dysfunction-associated steatohepatitis (MASH) is often referred to as a “silent disease,” as it typically shows no signs of symptoms in early stages. But it can come with certain nonspecific symptoms.

MASH is a chronic liver disease that occurs when fat builds up in the liver. It’s a serious condition that, left undetected, can progress to liver damage, cirrhosis, and even liver failure. Previously, MASH was known as nonalcoholic steatohepatitis (NASH) since people who drink very little or no alcohol often develop the condition.

While most people with MASH don’t have symptoms, some people may develop nonspecific symptoms with no known explanation.

If you experience any of the following symptoms, it may be a good idea to check in with your doctor. These symptoms don’t automatically mean you have MASH, but your doctor can help you determine the root cause. And if you do have MASH, early detection can help you identify and treat the condition before liver damage occurs.

Fatigue is an often overwhelming sense of feeling tired, even after a good night’s sleep.

Some people who develop MASH experience unexplained fatigue.

According to a 2023 article, even early stages of MASH can lead to fatigue. However, researchers noted that the exact cause of fatigue was not always clear, and it may be due to muscle loss, which can occur due to liver cirrhosis or severe scarring on the liver. So, you may not experience fatigue until the later stages of MASH.

Muscle weakness can occur as a sign of liver issues such as MASH.

As MASH progresses, cirrhosis can develop, which can lead to muscle loss. As you lose muscle mass, it can lead to a general feeling of weakness throughout the body.

As MASH progresses, it can lead to abdominal pain. This type of pain can be felt in the upper right area of the abdomen, where the liver is located. MASH-related abdominal pain may be the result of liver enlargement.

As the liver becomes more damaged, it can lead to fluid buildup in the abdomen or legs. This buildup of fluids can be a sign of liver failure.

If fluid buildup occurs, you may notice swelling in your stomach (known as ascites), legs, or ankles.

The amount of fluid buildup can vary. Small amounts may go unnoticed, but when larger volumes of liquid fill the abdomen, you may notice weight gain and increased waist circumference.

The swelling and pain associated with larger volumes of fluid buildup can become uncomfortable. The abdomen may become hard and resemble a pregnancy belly. The swelling can also cause the belly button to become pushed out.

Loss of appetite can be a sign of MASH. Abdominal pain, swelling, or discomfort could lead to not wanting to eat as much.

If you experience a reduced appetite, it can also lead to unintended weight loss.

As MASH progresses, you may notice changes in your sleep.

Some people who have MASH also have sleep apnea. Sleep apnea is a condition in which you stop breathing momentarily while asleep. This disrupts your sleep and negatively effects sleep quality, so you may feel excessively tired or fatigued during the day.

MASH may be associated with the development of mental health conditions, including anxiety and depression. These mental health issues can become worse as MASH progresses and causes increased or more severe symptoms.

Itchy skin can be a sign of liver issues associated with MASH. Significant itch has even been associated with a reduced quality of life.

You may not notice an enlarged liver yourself. But if you go for an examination, your doctor may find that you have liver enlargement.

As MASH progresses, it can lead to changes in behavior and thinking.

When liver damage prevents the liver from doing its job, toxins can build up in the blood and enter the brain. As a result, you may develop a brain disorder known as hepatic encephalopathy. This causes temporary brain impairment that can lead to symptoms such as:

  • confusion
  • forgetfulness
  • impaired concentration
  • mood or personality changes
  • misjudgment
  • worsened handwriting

More severe cases of hepatic encephalopathy may also lead to:

  • shaking of the hands or arms
  • seizures
  • severe personality changes
  • slowed movements
  • slurred speech

It’s possible to have MASH and not know. Symptoms of MASH may not develop for years or even decades. Once you do develop symptoms, it may be a sign your liver has already been permanently damaged.

You may want to speak with your doctor if you develop some of these nonspecific symptoms and have potential risk factors for MASH, including:

  • having overweight or obesity
  • insulin resistance or type 2 diabetes
  • metabolic syndrome or traits associated with it, such as a large waist circumference, high blood pressure, or high cholesterol levels
  • abnormal levels of fats in your blood

The best way to detect MASH is to get regular health checks with your doctor. Blood tests can help check for potential issues with the liver.

If your doctor suspects MASH or similar underlying conditions, they will likely run more tests.

MASH is a liver condition that develops slowly over the course of several years or decades. It often does not cause any symptoms until later stages when liver damage has occurred.

Symptoms are often nonspecific, so a doctor will need to run tests to determine the underlying cause, whether it’s MASH or something else.

People with certain conditions have a higher risk of developing MASH, for example, having obesity or living with type 2 diabetes. If symptoms of MASH develop, they should consider talking with a doctor.