Fatty liver disease is now one of the most common liver conditions in the world, and most people who have it do not know. It often causes no symptoms for years. The good news is that in its early stages it can frequently be improved, and even reversed, with lifestyle changes. This guide explains the new name for the condition, who is at risk, how it is diagnosed and what helps.
What is fatty liver disease?
Fatty liver disease means extra fat has built up in the liver. In 2023, international liver societies updated the names to better reflect the causes:
- MASLD (metabolic dysfunction-associated steatotic liver disease): fat in the liver linked to at least one metabolic risk factor, such as excess weight, type 2 diabetes, high blood pressure or abnormal cholesterol. This replaces the older term NAFLD (non-alcoholic fatty liver disease).
- MASH (metabolic dysfunction-associated steatohepatitis): a more serious form in which the liver is also inflamed and damaged. It replaces the term NASH.
- MetALD: fatty liver with both metabolic risk factors and higher alcohol intake.
- Alcohol-associated liver disease: liver damage mainly caused by alcohol.
Over time, MASH can lead to scarring (fibrosis), severe scarring (cirrhosis), liver failure and liver cancer. MASLD also raises the risk of heart disease, which is the most common cause of death in people with the condition.
Who is at risk?
- Overweight or obesity, especially extra fat around the waist
- Type 2 diabetes or prediabetes
- High blood pressure
- High triglycerides or low HDL cholesterol
- Metabolic syndrome
- Obstructive sleep apnea
- Polycystic ovary syndrome (PCOS)
- An underactive thyroid
- Older age
MASLD can also occur in people who are not overweight.
Symptoms
Most people have no symptoms, especially in the early stages. When symptoms occur, they may include:
- Tiredness
- Discomfort or a dull ache in the upper right abdomen
Signs of advanced liver disease (cirrhosis) can include:
- Yellowing of the skin or eyes (jaundice)
- Swelling of the abdomen or legs
- Easy bruising or bleeding
- Itchy skin
- Confusion or drowsiness
- Spider-like blood vessels on the skin
How fatty liver is diagnosed
Fatty liver is often found by chance on a blood test or scan done for another reason.
- Blood tests: liver enzymes (ALT and AST) may be raised, although they can be normal even with significant liver disease.
- Imaging: ultrasound commonly shows fat in the liver.
- Fibrosis assessment: your clinician may calculate a FIB-4 score from routine blood tests to estimate the chance of liver scarring. If the score is not low, the next step is often a vibration-controlled transient elastography scan (such as FibroScan) or another test that measures liver stiffness.
- Liver biopsy: occasionally needed when the diagnosis or degree of damage is unclear.
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Your clinician will also check for other causes of liver disease, such as viral hepatitis and certain medicines.
How to reverse fatty liver
Lose weight gradually
Weight loss is the most effective treatment.
- Losing 5% of body weight can reduce liver fat.
- Losing 7% to 10% or more can reduce inflammation and may improve scarring.
Aim for steady loss of about 1 to 2 pounds a week. Very rapid weight loss is not recommended.
Eat a Mediterranean-style diet
- Plenty of vegetables, fruit, whole grains, beans and lentils
- Olive oil, nuts and seeds as the main fats
- Fish several times a week
- Less red and processed meat
- Fewer sugary drinks and foods, especially those high in fructose
- Fewer refined carbohydrates and ultra-processed foods
Be active
Aim for at least 150 minutes of moderate activity a week, plus strength training. Exercise reduces liver fat even without large amounts of weight loss.
Limit or avoid alcohol
Alcohol adds further stress to the liver. People with significant fibrosis or cirrhosis should avoid alcohol completely.
Manage related conditions
Controlling blood sugar, blood pressure and cholesterol protects both your liver and your heart. Statins are generally safe for people with fatty liver and are often recommended to reduce heart risk.
Coffee
Several studies link regular coffee drinking with lower liver scarring. Unsweetened coffee can be part of a healthy diet for many people.
Medicines for MASH
Lifestyle change is the foundation of treatment, but medicines are now available for some people with MASH:
- Resmetirom (Rezdiffra) received FDA accelerated approval in 2024 for adults with MASH and moderate to advanced liver fibrosis without cirrhosis, used together with diet and exercise.
- Semaglutide (Wegovy) received FDA accelerated approval in August 2025 for adults with MASH and moderate to advanced fibrosis without cirrhosis, alongside diet and exercise.
Some diabetes and weight-loss medicines, and in selected cases weight-loss (bariatric) surgery, can also reduce liver fat. A liver specialist can advise whether medicine is right for you.
Be cautious with herbal supplements marketed for “liver detox”; some can actually harm the liver.
The American Liver Foundation and the NIDDK have more information.
Frequently asked questions
Can fatty liver go away?
Yes. In earlier stages, liver fat and inflammation can improve significantly with weight loss and healthy habits. Even some scarring may improve.
Is fatty liver serious?
Simple fatty liver is usually not harmful on its own, but it can progress to MASH, fibrosis and cirrhosis in some people. It also signals higher heart disease risk.
Do thin people get fatty liver?
Yes. People with a normal body weight can develop MASLD, especially if they have insulin resistance or carry fat around the abdomen.
The bottom line
Fatty liver disease, now called MASLD, is common and usually silent. If you have diabetes, excess weight or other metabolic risks, ask your clinician about checking your liver. Gradual weight loss, a Mediterranean-style diet, regular exercise and limiting alcohol are the most powerful treatments.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.