Prednisone is a commonly prescribed corticosteroid used to treat inflammation. But since it’s processed through the liver, it may increase your risk of NAFLD (now called MASLD).

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called nonalcoholic fatty liver disease (NAFLD), is a common condition that’s caused by the buildup of fat in the liver. MASLD doesn’t always cause symptoms, nor does it always lead to further complications. But it can increase the risk of more serious liver health conditions.

NAFLD to MASLD name change

Nonalcoholic fatty liver disease (NAFLD) is now known as metabolic dysfunction-associated steatotic liver disease (MASLD). This new name is more accurate and helps reduce the stigma associated with its older name.

A group of multinational liver societies and organizations, including the American Association for the Study of Liver Diseases (AASLD), developed and finalized the name change and announced it in June 2023.

Prednisone is a corticosteroid that doctors use to treat inflammation in a variety of health conditions. But because your liver processes this medication, it might not be the best choice if you’re already at high risk of MASLD.

This article looks at how prednisone affects liver function and may increase your risk for MASLD.

Fast facts about MASLD

  • MASLD (NAFLD) is a liver health condition that happens when excess fat builds up in your liver.
  • MASLD is very common. About 24% of U.S. adults and 25% of the global population have MASLD.
  • Some people are unaware they have MASLD because the condition often causes no symptoms.
  • The risk of MASLD increases with conditions such as obesity and type 2 diabetes.

Prednisone is a corticosteroid medication. It lowers the immune system’s response and can help reduce inflammation and relieve pain.

Doctors prescribe prednisone and other corticosteroid medications to treat conditions such as:

Prednisone acts as a replacement for steroids that are normally produced by your body. Steroids are processed in your liver. This means that your liver will process medications such as prednisone. And this can increase your risk for MASLD.

But, sometimes, prednisone can help your liver. Prednisone and other corticosteroids can reduce inflammation throughout your body, including in your liver.

Doctors usually prescribe prednisone to lower liver inflammation, especially the liver inflammation that occurs due to autoimmune hepatitis. For many people with liver inflammation, the benefit of prednisone is greater than the increased risk of MASLD.

Prednisone can increase the risk of MASLD. If you already have MASLD, your doctor might suggest different options to treat inflammation or prescribe a low dose.

Depending on your condition, a doctor may suggest alternatives to prednisone that may be suitable for you. These may include:

If your doctor prescribes prednisone, they may regularly check your liver to ensure your MASLD is not worsening.

Taking prednisone and other corticosteroids is a risk factor for MASLD. The risk increases the longer you take one of these medications.

According to a 2020 study, prednisone can increase blood sugar and can even cause drug-induced diabetes. Insulin resistance (a hallmark of diabetes) is also linked to MASLD. This is why diabetes is a risk factor for MASLD and why prednisone could increase the risk of MASLD.

Other risk factors for MASLD include:

Studies on additional risk factors for MASLD are still ongoing. For instance, researchers are looking into whether the following factors play a role in its development:

  • genetics
  • family history
  • ethnicity
  • gender
  • diet
  • environment

MASLD is more common in certain parts of the world and in certain ethnicities, but scientists don’t know why this occurs. Additionally, there seems to be a link between stomach bacteria and MASLD, but this isn’t fully understood. More research is needed for this link.

Corticosteroids aren’t the only medications that can increase the risk of MASLD. Other medications linked to developing MASLD include:

Additionally, certain medications can be hard on your liver. These medications can increase the risk of multiple types of liver damage and disease. They include:

Prednisone is a corticosteroid medication. Your liver processes this medication, and it can increase your risk of MASLD.

If you already have or are at high risk of MASLD, you might need to consider alternative medications or take prednisone at low doses. Depending on your condition, a doctor may suggest alternatives to prednisone that may be suitable for you.

Prednisone is one of several factors that can increase the risk of MASLD. Other risk factors, including blood pressure, cholesterol, weight, and insulin resistance, can be managed through lifestyle changes.

Your doctor can help you create a plan to lower your risk of MASLD.