Photo courtesy of STOCK

By Knowridge

A person can look and feel well while serious liver damage is developing quietly.

A new study from the University of California San Diego School of Medicine suggests that this may be especially important for some adults under 50 who have fatty liver disease and type 2 diabetes.

The liver performs hundreds of essential jobs, from processing nutrients to removing harmful substances from the blood. It can tolerate a great deal of stress, but repeated injury can slowly replace healthy tissue with permanent scars.

One growing source of that injury is metabolic dysfunction-associated steatotic liver disease, known as MASLD.

The condition occurs when too much fat collects in the liver in connection with metabolic health problems and is strongly associated with obesity and type 2 diabetes.

Fat in the liver does not always cause serious illness.

Many people live for years without major liver damage, while a smaller group develops inflammation and increasing amounts of scar tissue.

When scarring becomes severe and changes the structure of the liver, the condition is called cirrhosis.

At that stage, the liver may still work for a time, but patients face a growing risk of liver failure, internal bleeding and liver cancer.

Cirrhosis usually takes years to develop, so it is often considered a disease of later adulthood.

Yet doctors have increasingly encountered younger patients whose MASLD has already progressed to advanced scarring.

To understand this group better, researchers examined data from roughly 2,400 adults participating in the national NASH Clinical Research Network.

All had MASLD confirmed by liver biopsy, a procedure in which a small sample of liver tissue is examined for fat, inflammation and scarring.

The investigators focused on when cirrhosis appeared.

About 25% of the cirrhosis cases in the study were diagnosed before age 50, showing that advanced MASLD is not limited to older people.

The researchers then looked for characteristics linked with this earlier disease.

Their results pointed to an important combination: metabolic illness, particularly type 2 diabetes, together with inherited genetic susceptibility.

Type 2 diabetes changes the way the body handles sugar and is often accompanied by insulin resistance and other metabolic problems.

These changes can encourage fat accumulation in the liver and may contribute to the processes that damage liver cells over time.

Genes may help explain why two people with similar body weight or diabetes histories can have very different liver outcomes.

Some inherited variants can make a person more likely to accumulate liver fat or develop inflammation and scarring.

The new findings suggest that, in certain people, genetic vulnerability and metabolic stress may work together and accelerate liver damage.

Senior researcher Dr. Rohit Loomba said early-onset cirrhosis therefore appears to have a distinct risk pattern rather than simply being ordinary cirrhosis that happened sooner.

The study also raises a practical problem for doctors trying to find these patients.

Because fatty liver disease can be silent, health professionals often rely on blood tests and risk calculators to decide who needs more detailed liver testing.

Age is included in several commonly used liver fibrosis scores.

That can unintentionally work against younger patients because their age lowers the calculated risk even when significant scarring is present.

The researchers found that almost one in three participants with early-onset MASLD cirrhosis had scores below the usual levels that would prompt additional evaluation.

In other words, a screening system intended to identify advanced disease could give some younger adults false reassurance.