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Understanding fatty liver

What it is, how it progresses, and what you can ask your doctor.

What it is

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a build-up of fat in the liver linked to metabolic factors like insulin resistance, extra weight around the middle, high blood sugar, high blood pressure, or high cholesterol. It used to be called non-alcoholic fatty liver disease (NAFLD) and was renamed in 2023. Most people feel no symptoms, which is why it often goes unnoticed.

How it can progress

  1. 1

    Fat in the liver

    (steatosis)

  2. 2

    Inflammation

    (MASH)

  3. 3

    Scarring

    (fibrosis)

  4. 4

    Severe scarring

    (cirrhosis)

Most people never reach the later stages, and earlier stages can improve with the right support.

Who is at higher risk

  • Type 2 diabetes or prediabetes
  • Extra weight, especially around the waist
  • High blood pressure
  • High triglycerides or low HDL cholesterol

Tests to ask your doctor about

Liver enzymes (ALT, AST)

A routine blood test. Helpful, but enzymes can look normal even when fat is present.

FIB-4 score

A calculation from your age, AST, ALT, and platelet count. Current guidelines use it as the first step to estimate scarring risk.

Liver stiffness scan or ELF test

If FIB-4 is not low, a FibroScan (elastography) or Enhanced Liver Fibrosis blood test gives a closer look at scarring.

Ultrasound

Can show fat in the liver, but is not reliable for measuring scarring.

What helps

Weight change, even modest

Research links losing 3-5% of body weight to less liver fat, about 7% to less inflammation, and about 10% to less scarring.

Mediterranean-style eating

Vegetables, legumes, whole grains, olive oil, fish, and poultry, with fewer ultra-processed foods and sugary drinks.

Regular movement

Walking, plus strength training a few times a week.

Limiting alcohol

Ask your doctor what is right for you.

Medication, for some

Two FDA-approved medicines are available for MASH with moderate to advanced scarring. Your doctor decides whether they fit.

This page is for education, not diagnosis. Your doctor can tell you what your results mean for you.

Sources

  • Le P, et al. JAMA Network Open. 2025;8(1):e2454707.
  • Rinella ME, et al. AASLD Practice Guidance on NAFLD. Hepatology. 2023.
  • AGA Clinical Care Pathway for MASLD. Gastroenterology. 2026.
  • Lancet Regional Health Europe. 2025 (MASH diagnosis rates).