- MASLD (metabolic dysfunction-associated steatotic liver disease, formerly called NAFLD) means extra fat has built up in the liver because of metabolic problems such as insulin resistance, not alcohol.
- It affects roughly one in three adults worldwide and usually causes no symptoms until it is advanced.
- It is largely reversible. Losing 5–10% of body weight, moving more and cutting sugary drinks can remove liver fat and even heal early scarring.
The liver is your metabolic control centre. It stores and releases sugar, makes cholesterol and processes fat. When the body takes in more energy than it can use, and especially when insulin resistance is present, the liver starts storing fat inside its own cells. A little is normal. When more than about 5% of the liver is fat, it is called a fatty liver.
In 2023, international liver societies renamed the condition MASLD to make clear that it is driven by metabolic health, and to remove stigma. You may still hear the older name, NAFLD (non-alcoholic fatty liver disease).
How common is it?
Younossi et al., Hepatology 2023 and J Hepatol 2019; AASLD Practice Guidance 2023; Vilar-Gomez et al., Gastroenterology 2015.
From fat to scarring: how it progresses
The stages of fatty liver disease
Most people with fatty liver never progress beyond the first stage. But in some, the fat triggers inflammation, called MASH (formerly NASH), which can slowly cause scarring. The amount of scarring (fibrosis) is the most important predictor of future liver problems. Importantly, the most common cause of death in people with MASLD is heart disease, not liver disease, because both share the same metabolic roots.
Who is at risk?
MASLD travels with the other parts of metabolic ill health. Your risk is higher if you have:
- type 2 diabetes or prediabetes;
- extra weight around the middle (see Visceral Fat);
- high triglycerides or low HDL cholesterol;
- high blood pressure;
- polycystic ovary syndrome, sleep apnea or an underactive thyroid.
How is it found?
Fatty liver usually causes no symptoms, though some people notice tiredness or a dull ache under the right ribs. It is often found by chance on an ultrasound or when a routine blood test shows raised liver enzymes (ALT). Normal liver enzymes do not rule it out.
Doctors now use a simple score called FIB-4, calculated from your age and routine blood tests, to estimate the risk of scarring. If the score is not low, a quick, painless scan such as transient elastography (FibroScan) measures liver stiffness. The American Diabetes Association recommends checking for fibrosis in adults with type 2 diabetes or prediabetes who have other risk factors.
How to reverse fatty liver
Weight loss needed for each benefit
Based on Vilar-Gomez et al., Gastroenterology 2015, and AASLD Practice Guidance 2023.
- Lose weight gradually, about 0.5–1 kg (1–2 lb) a week. Very rapid weight loss can stress the liver.
- Cut sugary drinks and added fructose, which the liver turns directly into fat.
- Eat a Mediterranean-style diet: vegetables, legumes, whole grains, olive oil, nuts and fish.
- Move every day. Both aerobic exercise and strength training reduce liver fat, even without weight loss.
- Limit alcohol. Alcohol adds to liver damage; people with scarring should avoid it.
- Manage diabetes, blood pressure and cholesterol. Statins are safe in fatty liver and protect the heart.
Medicines are now available too. In 2024 and 2025, the US FDA approved the first two medicines for MASH with moderate to advanced scarring: resmetirom and semaglutide. GLP-1 medicines and pioglitazone may also help people with diabetes. Your doctor can advise whether they suit you.
MythFatty liver only affects people who drink alcohol or are very overweight.
FactMASLD is driven by insulin resistance and belly fat. It is common in people with diabetes, and can occur at a normal weight.
Common questions
Is coffee good for the liver?
Several large studies link regular coffee drinking with less liver scarring. It is not a treatment, but 2–3 cups a day of plain coffee appear safe and possibly helpful for most adults, if you tolerate caffeine.
Can a liver detox or supplement clear fatty liver?
No. There is no good evidence that detox products clear liver fat, and some herbal supplements can harm the liver. Weight loss, exercise and diet are what work.
- MASLD is fat build-up in the liver driven by insulin resistance; it affects about one in three adults.
- It is usually silent; a FIB-4 score and, if needed, a FibroScan check for scarring.
- Losing 5–10% of body weight, daily activity and cutting sugary drinks can reverse it.
- Related: Visceral fat and How muscle protects your metabolism.
Sources
- Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966–1986.
- Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797–1835.
- Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335–1347.
- Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019;71(4):793–801.
- Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–378.
- American Diabetes Association Professional Practice Committee. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
This article is for general education and is not a substitute for advice from your own doctor, diabetes educator or pharmacist.