What is fatty liver (MASLD)?
Fatty liver means extra fat is stored inside the liver cells. When it is linked to weight, blood sugar, blood pressure or blood fats, doctors call it MASLD.
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Patient questions and answers
28 short answers to the questions patients ask most, in plain words. Each answer lists the official guidelines it is based on.
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The basics 6
Why did the name change from NAFLD to MASLD?
In 2023, liver societies changed the name to describe the real cause, metabolic problems, and to remove words that felt judgemental.
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What is MASH, and how is it different?
MASH is the active, inflamed form of MASLD. The fat is now harming liver cells, and over years this can cause scarring.
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How common is fatty liver?
Very common. About 1 in 3 adults worldwide has fatty liver. In the Middle East it is closer to 4 in 10, and about 7 in 10 people with type 2 diabetes.
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What causes fatty liver?
Mostly insulin resistance: the body struggles to handle sugar and fat, so the liver stores the extra as fat.
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Is fatty liver serious?
For most people it stays mild. But in some it leads to scarring, cirrhosis or liver cancer, and it raises the risk of heart disease in everyone.
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Symptoms and tests 6
Does fatty liver cause symptoms?
Usually not. Many people feel completely well, even when there is scarring.
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My ultrasound says "fatty liver". What now?
Don't panic and don't ignore it. The next step is to find out if there is scarring, starting with a simple blood-test score called FIB-4.
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What are liver enzymes (ALT and AST)?
ALT and AST are proteins that leak into the blood when liver cells are irritated. They are clues, not a full answer.
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What is the FIB-4 score?
FIB-4 is a free score calculated from your age and three routine blood results. It tells your doctor whether serious scarring is unlikely or needs a closer look.
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What is a FibroScan, and how do I prepare?
FibroScan is a quick, painless scan that measures how stiff your liver is. Stiffer means more scarring.
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Do I need a liver biopsy?
Usually not. Today most people are assessed with blood-test scores and scans. A biopsy is kept for unclear cases.
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Daily life 7
How much weight do I need to lose?
Even 5% of your body weight helps. Losing 7–10% can calm inflammation, and 10% or more can improve scarring.
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What should I eat?
A Mediterranean-style diet works best: lots of vegetables, legumes, whole grains, fish and olive oil, with fewer sugary and processed foods.
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Which drinks are good or bad for my liver?
Water is best. Plain coffee may even help the liver. Sugary drinks and packaged juices are among the worst.
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What exercise helps fatty liver?
Any activity you can keep doing. Aim for 150 minutes a week of brisk walking or similar, plus some strength exercise.
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Can I fast in Ramadan with fatty liver?
Most people with fatty liver can fast safely. Check with your doctor first if you have diabetes, cirrhosis or take several medicines.
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Is alcohol safe with fatty liver?
No amount is proven safe. Alcohol adds to the damage from fat, so less is better and none is best if there is scarring.
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Do herbs, "detox" or supplements help?
No herb, detox or supplement is proven to treat fatty liver. Some herbal products can even harm the liver.
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Treatment 3
Is there a medicine for fatty liver?
Yes, for some people. Two medicines are now approved in several countries for MASH with moderate or advanced scarring. They work alongside lifestyle change, not instead of it.
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Are statins (cholesterol pills) safe for my liver?
Yes. Statins are safe in fatty liver and protect your heart. Do not stop them because of fatty liver or mildly raised enzymes.
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Does weight-loss surgery help the liver?
Yes. For people with obesity who qualify for surgery, it can clear MASH and improve scarring.
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Risks and follow-up 3
Can fatty liver turn into cirrhosis or cancer?
It can, in a small share of people, usually over many years. The risk is mainly in people who already have advanced scarring.
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Why does my heart matter if I have fatty liver?
Because heart disease, not liver disease, is the most common cause of death in people with fatty liver.
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How often should I be checked?
It depends on your scarring stage. Low-risk people are usually re-checked every 1 to 3 years; people with more scarring are seen more often.
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Special situations 3
I'm not overweight. Can I still have fatty liver?
Yes. This is called lean MASLD. It is linked to belly fat, insulin resistance and genes, and it needs the same checks.
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Can children get fatty liver?
Yes, especially children with obesity. It needs care from a paediatric specialist and the whole family's help.
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What about fatty liver and pregnancy?
Fatty liver raises the risk of diabetes and high blood pressure in pregnancy. Plan ahead with your doctor, ideally before you conceive.
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Official organisations
Our answers follow guidance from these societies and patient charities. Visit them for more.
- EASL – European Association for the Study of the Liver
- AASLD – American Association for the Study of Liver Diseases
- AGA – American Gastroenterological Association
- ACG – American College of Gastroenterology
- WGO – World Gastroenterology Organisation
- GLI – Global Liver Institute (patient advocacy)
- British Liver Trust (patient charity)
- American Liver Foundation (patient charity)