Understanding Fatty Liver Disease (MASLD)
Fatty liver disease is one of the most common health conditions in the United States and around the world. Millions of people have it, and many do not even know they have it. In many cases it is discovered by accident during routine blood work or an ultrasound done for another reason.
Although fatty liver disease often causes no symptoms at first, it can become serious over time if it is ignored. The good news is that in many people it can be improved or even reversed with healthy lifestyle changes.
This article explains what fatty liver disease is, what causes it, why it matters, and what can be done to improve it.
What Is Fatty Liver Disease?
Your liver is one of the most important organs in your body. It performs hundreds of jobs that keep you healthy, including:

• Filtering toxins from the blood
• Processing nutrients from food
• Helping control blood sugar and cholesterol
• Producing proteins needed for blood clotting
• Storing energy for later use

Normally the liver contains a small amount of fat. However, when too much fat builds up inside liver cells, the condition is called fatty liver disease.
Doctors generally diagnose fatty liver disease when more than about 5% of the liver contains fat.
There are two major categories of fatty liver disease:
Alcohol-Related Liver Disease
This occurs when heavy alcohol use damages the liver and causes fat to build up.
Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)
This is the most common type. It was previously called Nonalcoholic Fatty Liver Disease (NAFLD).
The name was changed because doctors now better understand that the condition is strongly connected to problems involving metabolism such as:

• Excess weight
• Insulin resistance
• Prediabetes and diabetes
• High cholesterol and triglycerides
• High blood pressure

Many people still know the condition by the older name NAFLD, but MASLD is now the preferred medical term.
What Causes MASLD?
MASLD develops when the body stores or produces more fat than the liver can safely handle.
Several things increase the risk.
Excess Weight
Being overweight, especially carrying extra weight around the abdomen, is one of the strongest risk factors.
When the body takes in more calories than it needs, some of that excess energy is stored as fat in the liver.
Insulin Resistance and Diabetes
Insulin is a hormone that helps control blood sugar.
When the body becomes resistant to insulin, the liver starts storing more fat. This is why fatty liver disease is very common in people with prediabetes or type 2 diabetes.
High Cholesterol and High Triglycerides
Abnormal cholesterol and triglyceride levels are closely linked to fatty liver disease.
Poor Diet
Diets high in:

• Sugary drinks
• Sweets and desserts
• White bread and processed carbohydrates
• Fast food
• Fried foods
• Highly processed foods

increase the risk of fatty liver disease.
Lack of Exercise
Physical activity helps the body burn fat for energy. A sedentary lifestyle makes fat buildup in the liver more likely.
Genetics
Some people inherit genes that make them more likely to develop fatty liver disease even if they are not overweight.
Certain Medications and Medical Conditions
Less commonly, fatty liver can be related to certain medications, rapid weight loss, sleep apnea, or other metabolic disorders.
What Are the Symptoms?
Many people with fatty liver disease have no symptoms at all, especially early on.
When symptoms occur they may include:

• Fatigue
• Low energy
• Mild discomfort or fullness in the upper right abdomen
• Feeling generally unwell

Because symptoms are often absent, fatty liver disease is commonly discovered after:

• Abnormal liver blood tests
• Ultrasound imaging
• CT or MRI scans

Why Can Fatty Liver Disease Become Serious?
Many people with fatty liver disease never develop serious liver damage. However, in some individuals the condition gradually worsens over time.
Fatty liver disease often develops in stages.
1. Simple Steatosis
Fat is present in the liver, but there is little or no inflammation.
Many people remain in this stage and never develop complications.
2. MASH (Metabolic Dysfunction–Associated Steatohepatitis)
Some people develop inflammation and injury to liver cells.
This more serious form of the disease is now called MASH. It was previously called NASH.
3. Fibrosis
Long-term inflammation can cause scar tissue to form in the liver.
4. Cirrhosis
Over time severe scarring may occur. This condition is called cirrhosis.
Cirrhosis can interfere with liver function and may eventually lead to liver failure.
5. Liver Cancer
People with advanced fatty liver disease and cirrhosis have an increased risk of developing liver cancer.
Fatty Liver Is Also Linked to Heart Disease
Fatty liver disease is not only a liver problem.
It is strongly associated with:

• Type 2 diabetes
• High blood pressure
• High cholesterol
• Stroke
• Heart disease

In fact, heart disease is the leading cause of death in people with MASLD.
How Is Fatty Liver Disease Diagnosed?
Doctors may suspect fatty liver disease based on:

• Elevated liver enzymes on blood tests
• Ultrasound findings
• CT or MRI scans

Additional testing may sometimes be done to determine whether inflammation or scarring is present.
These tests may include:

• Special ultrasound tests that measure liver stiffness
• MRI-based liver testing
• Blood marker panels
• Occasionally a liver biopsy

Most patients do not need a liver biopsy.
Can Fatty Liver Disease Be Reversed?
In many people the answer is yes.
One of the encouraging things about fatty liver disease is that it often improves with lifestyle changes, especially in the early stages.
Research shows that even modest weight loss can significantly reduce liver fat and inflammation.
How Is MASLD Treated?
There is currently no single medication that cures MASLD for everyone, although newer medications are now becoming available for selected patients.
The most important treatment is improving overall metabolic health.
Weight Loss
Weight loss is the most effective treatment for most patients.
Studies show that:

• Losing about 5% of body weight can reduce liver fat
• Losing 7–10% can improve inflammation
• Greater weight loss may improve liver scarring in some patients

Weight loss should be gradual and achieved with healthy eating and exercise rather than crash diets.
Healthy Diet
A liver-friendly diet includes:

• Vegetables and fruits
• Whole grains
• Beans and legumes
• Fish and lean protein
• Healthy fats such as olive oil, nuts, and avocado

Many experts recommend a Mediterranean-style diet because studies show it can reduce liver fat and improve heart health.
Foods and drinks that should be limited include:

• Sugary beverages such as soda
• Highly processed foods
• Excessive sweets
• Fried foods
• Excessive alcohol

Exercise
Exercise helps the body burn fat and improves insulin resistance.
Experts generally recommend:

• At least 150 minutes of moderate exercise each week

Examples include:

• Brisk walking
• Cycling
• Swimming
• Strength training
• Dancing

Even moderate exercise can improve liver health.
Managing Diabetes, Cholesterol, and Blood Pressure
Proper control of:

• Blood sugar
• Cholesterol
• Triglycerides
• Blood pressure

is extremely important because these conditions are closely linked to fatty liver disease and heart disease.
Alcohol
Even though MASLD occurs in people who do not drink heavily, alcohol can worsen liver injury.
People with fatty liver disease should discuss alcohol intake with their healthcare provider.
Medications
Several newer medications are being studied or used in selected patients with obesity, diabetes, or MASH.
Some diabetes and weight-loss medications have also been shown to improve fatty liver disease in certain patients.
Treatment decisions should always be individualized and discussed with a physician.
Coffee and Fatty Liver
Some studies suggest that regular coffee consumption may help reduce liver inflammation and scarring in fatty liver disease.
While coffee is not a cure, moderate coffee intake may have some liver benefits for many people.
Vaccinations
Because the liver is already under stress in people with fatty liver disease, many physicians recommend vaccination against Hepatitis A and Hepatitis B if a patient is not already immune.
The Bottom Line
Fatty liver disease is extremely common, but it should not be ignored.
The condition often causes no symptoms, yet it can sometimes progress to serious liver disease over time.
The encouraging news is that fatty liver disease is often preventable and reversible, especially when detected early.
Healthy lifestyle changes such as losing excess weight, improving diet, exercising regularly, controlling blood sugar and cholesterol, and avoiding excess alcohol can dramatically improve liver health.
If you have been told that you have fatty liver disease, speak with your healthcare provider about the best plan for you. Small changes made today can make a major difference in your long-term health.

The same advice we give diabetics will also reduce the risks from fatty liver. This booklet written with diabetics in mind will provide advice and information on diet that is just as appropriate for patients with fatty liver. Click on the image below to download the booklet.