Overview

Fatty Liver Disease (MASLD) is a common condition where excess fat builds up in the liver, affecting up to 30-40% of adults. It is closely tied to metabolic health conditions like obesity, diabetes, and high cholesterol. Most people have no symptoms, but MASLD can progress to liver inflammation, scarring (fibrosis), and even cirrhosis if untreated. The condition exists on a spectrum, and not everyone will experience progression. In fact, many people remain stable or improve with early lifestyle intervention. The cornerstone of treatment is improving metabolic health through weight loss, balanced nutrition, and regular physical activity. In selected patients, medications targeting weight loss and metabolic risk factors may also be recommended. When identified early, MASLD is often reversible, and progression to advanced liver disease can frequently be prevented.

What Is Fatty Liver?

Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) – formerly known as fatty liver disease – occurs when excess fat builds up in the liver. While a small amount of liver fat is normal, MASLD is diagnosed when more than 5% of the liver’s weight is fat, which can begin to impair normal liver function.

MASLD is the most common chronic liver disease worldwide, affecting approximately 30–40% of adults. Over time, MASLD can progress from simple fatty liver to liver inflammation, scarring (fibrosis), and in some cases cirrhosis, which represents permanent liver damage.

What Are Risk Factors for Fatty Liver (MASLD)?

MASLD develops when the liver stores more fat than it can process. Common risk factors include:

• Overweight or obesity, particularly abdominal (central) obesity
• Type 2 diabetes or prediabetes
• High blood pressure
• Elevated triglycerides or low HDL (“good”) cholesterol
• Physical inactivity
• Diets high in added sugars, fructose, and saturated fats
• Genetic factors or a family history of fatty liver disease

Approximately 10–20% of people with MASLD are not overweight. MASLD can also occur in lean individuals, especially when metabolic risk factors are present.

If you’re unsure whether these risk factors apply to you, our physicians can help assess your risk and determine whether further evaluation is appropriate.

What Are the Symptoms of Fatty Liver (MASLD)?

Most people with MASLD have no symptoms, particularly in the early stages. When symptoms do occur, they may include:

• Fatigue or low energy
• Discomfort or fullness in the right upper abdomen
• Loss of appetite or nausea

In more advanced disease, especially with significant fibrosis or cirrhosis, symptoms may include:

• Yellowing of the skin or eyes (jaundice)
• Swelling of the abdomen or legs
• Easy bruising or bleeding
• Confusion or difficulty concentrating

Normal liver enzyme levels do not rule out MASLD. Significant liver disease can be present even when blood tests appear normal.

How Is Fatty Liver (MASLD) Diagnosed?

Because MASLD often causes no symptoms, it is frequently discovered during routine testing. Evaluation may include:

• Blood tests showing elevated liver enzymes or metabolic abnormalities
• Imaging studies, such as abdominal ultrasound, CT scan, or MRI showing fat in the liver
• Elastography (FibroScan®), a specialized ultrasound that measures liver stiffness to assess scarring
• Liver biopsy in select cases to confirm inflammation and determine the degree of fibrosis

How Is Fatty Liver (MASLD) Treated?

There is no single medication cure for MASLD. Treatment focuses on improving metabolic health and preventing disease progression.

Weight Loss (Most Effective Therapy)

• 3–5% weight loss: Reduces liver fat
• 7–10% weight loss: Improves liver inflammation
• ≥10% weight loss: Offers the greatest benefit and may improve fibrosis

Nutrition

A Mediterranean-style diet is recommended:

• Vegetables, fruits, whole grains
• Fish, olive oil, nuts, and beans
• Limit red meat, processed foods, and added sugars

Medication

In some patients, particularly those with diabetes or more advanced liver disease, certain medications may be used in addition to lifestyle changes. These may include weight-loss and diabetes medications, such as GLP-1–based therapies, which can help reduce liver inflammation, as well as other metabolic or liver-targeted treatments chosen based on an individual’s health profile. Medication decisions are personalized and made in consultation with your physician.

Why Is Treating Fatty Liver (MASLD) Important?

Fatty Liver Disease (MASLD) affects more than just the liver. It is closely linked to overall metabolic and cardiovascular health.

• Heart disease is the leading cause of serious illness and death in people with MASLD, due to shared risk factors such as insulin resistance and abnormal cholesterol
• MASLD can increase the risk of liver cancer, particularly when fibrosis or cirrhosis is present
• Regular monitoring is important, even when liver disease appears mild

The good news is that most people with MASLD do not develop severe liver complications, especially when the condition is identified early. Improving metabolic health through weight loss, healthy eating, physical activity, and proper management of chronic conditions can help protect both liver and heart health.

Fatty liver (MASLD) is common, often silent, and closely linked to metabolic health. With early detection and the right guidance, lifestyle changes can significantly reduce the risk of liver and heart-related complications. Our physicians are experienced in helping patients develop personalized plans to protect their liver and overall health.