Fatty liver disease
MASLD (formerly NAFLD), metabolic dysfunction-associated steatotic liver disease
Chronic conditionExtra fat builds up in the liver, usually alongside insulin resistance or extra weight. It's very common and often silent, but it can lead to scarring.
Medical Disclaimer
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
What happens
Fatty liver disease is now called MASLD. It's diagnosed when fat builds up in the liver along with at least one metabolic risk factor, such as extra weight around the waist, high blood sugar, high blood pressure, or high triglycerides. In some people the fat causes inflammation, called MASH (formerly NASH). Over years this can cause scarring (fibrosis) and, in a small share of people, cirrhosis or liver cancer. The amount of scarring matters most for your long-term health. Heart disease is the most common cause of death in people with MASLD, so heart health is part of care.
Who gets it
MASLD affects about 1 in 3 adults. Risk is higher with type 2 diabetes, extra weight, high triglycerides, and sleep apnea. Women with PCOS or low thyroid function are at higher risk, and risk rises after menopause.
Signs worth getting checked
- Often no symptoms
- Fatigue
- A dull ache or fullness in the upper right belly
- Weight gain around the waist
- Signs of insulin resistance, such as darker skin in body folds
- In advanced disease, yellow skin or eyes, a swollen belly or legs, or easy bruising
Labs to ask about
- Liver enzymes (ALT and AST), which can be normal even with fatty liver
- FIB-4 score, calculated from age, liver enzymes, and platelet count, to estimate scarring
- Elastography, such as FibroScan, if FIB-4 isn't low
- Liver ultrasound
- A1c, lipid panel, and TSH
- Hepatitis B and C screening and iron studies to rule out other causes
Treatments your doctor may discuss
- Losing 7% to 10% of body weight, which can reduce liver fat and inflammation
- A Mediterranean-style diet and regular exercise, which help even without weight loss
- Resmetirom or semaglutide for MASH with moderate or advanced scarring
- Vitamin E for some people without diabetes who have MASH, only under a doctor's care
- Managing blood sugar, blood pressure, and cholesterol
Supportive steps to discuss with your provider
- Limit alcohol, and avoid it if you have significant scarring.
- Cut back on sugary drinks and highly processed foods.
- Aim for at least 150 minutes of activity a week, including strength training.
- Ask whether coffee fits your diet. Coffee drinkers tend to have less liver scarring in studies.
- Check with your provider before taking herbal or liver supplements. Some can harm the liver.
See a doctor promptly if you have
- Vomiting blood or black stools: go to the emergency room
- Confusion or unusual drowsiness with liver disease: go to the emergency room
- Yellow skin or eyes
- A swollen belly or legs
- Liver enzymes that stay high, or a FIB-4 score that isn't low
Related conditions
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.