Polypharmacy And Masld: Why Taking Many Medicines Can Matter For Your Health

Author: Gerald Cheruiyot 

Reviewed by: Sarah Armes, Sarah Anderson and Sumantra (Shumone) Ray 

UNDERSTANDING MASLD AND TREATMENT COMPLEXITY 

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as NAFLD (Non–alcoholic Fatty Liver Disease), is now estimated to affect more than one-third of adults worldwide (https://www.nature.com/articles/s41572-025-00599-1). It is closely linked with overweight and obesity, type 2 diabetes, high cholesterol, and high blood pressure. 

As a result, many people living with MASLD are prescribed several medicines at the same time. These medicines may be needed to manage blood sugar, blood pressure, cholesterol, or other health problems alongside liver disease. While medicines are an important part of care, managing many of them together can place a significant burden on daily life and wellbeing. 

A recent systematic review of research published in BMJ Nutrition, Prevention and Health examined how common it was for individuals with MASLD to take multiple medicines at the same time and what this may mean for them.  

HOW COMMON IS POLYPHARMACY IN MASLD? 

The review examined six studies from the United States, Australia and Italy. Across these studies, between one quarter and almost nine out of ten adults with MASLD were taking multiple long-term medicines. This wide range reflects differences in healthcare systems and how polypharmacy was defined. 

When the most comparable studies were combined, around eight in ten adults with MASLD were managing complex medication routines. In hospital and specialist care settings, people were often prescribed close to ten long-term medicines, highlighting how demanding treatment can become. 

HOW TAKING MANY MEDICINES AFFECTS DAILY LIFE 

For many people living with MASLD, taking several medicines each day can affect how they feel and function in everyday life. People managing multiple medicines often report feeling more tired, having less energy and finding it harder to carry out daily activities such as work, household tasks, and social life. 

Ongoing symptoms linked to liver disease, such as persistent tiredness, poor sleep, and muscle cramps, are also more commonly reported by those taking many medicines. Over time, these symptoms can build up and make day-to-day life more challenging, particularly for people with more advanced forms of the condition. 

In some cases, managing many medicines is linked to a higher chance of needing hospital care, especially among people with more severe liver disease. Hospital admissions can be disruptive and stressful, and may affect confidence, independence, and overall wellbeing. 

Taking several medicines is more common among older adults and people living with more than one long-term condition, such as diabetes or heart disease. For some, this means juggling complex routines, dealing with side effects and feeling overwhelmed by treatment, especially when the benefits of each medicine are not always clear. 

WHY MEDICINE BURDEN MATTERS IN MASLD 

The liver plays a central role in breaking down medicines. In MASLD, this process can be altered, leading to medicines remaining in the body for longer or interacting with each other in unexpected ways. This can increase the risk of side effects and harmful drug interactions. 

Managing many medicines can also make treatment routines harder to follow, increase fatigue and discomfort, and affect overall wellbeing. The review highlighted knowledge gaps, including limited information on whether all prescribed medicines are necessary or whether some could be safely reduced. 

WHAT THIS MEANS FOR CARE AND SUPPORT 

Regular medication reviews are an important part of care for people living with MASLD. Working with healthcare professionals, including doctors, pharmacists, and dietitians, can help ensure medicines remain appropriate, effective, and as simple as possible. 

Non-drug approaches are also central to MASLD management. Strong evidence shows that changes in diet, physical activity, and sustained weight loss can improve liver health and metabolic conditions. In some cases, these improvements may reduce the need for certain medicines. Nutrition-focused support, therefore, plays a key role in improving health while helping to minimise unnecessary medication burden. 

LOOKING AHEAD 

As MASLD becomes more common worldwide, managing multiple medicines will remain a growing challenge. Future research should explore how medicine use changes over time, identify which medicines provide the greatest benefit and assess safe ways to reduce medication burden alongside nutrition and lifestyle support. 

Improving care in MASLD should involve not only the introduction of additional treatments (when needed and appropriate), but also the optimisation of existing therapies, support for sustainable lifestyle changes, and a focus on interventions that enhance long-term quality of life. 

KEY TAKEAWAYS

 

• Many people living with MASLD take several long-term medicines. 

• Taking many medicines can affect energy levels, daily activities and wellbeing. 

• Managing complex medication routines may increase the risk of side effects and hospital admissions. 

• Regular medication reviews help ensure medicines remain necessary and safe. 

• Diet, physical activity and weight management play a central role in improving health and may reduce reliance on medicines. 

References 

BMJ Nutrition, Prevention and Health (2025). Polypharmacy in adults with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis. Volume 8, Issue 2, Article 677. 

Available at: https://nutrition.bmj.com/content/8/2/677 

In November 2024, NNEdPro presented a summary of current understanding of MASLD and lifestyle factors with talks by key researchers in this area. Read more about it here.