1. Metabolic dysfunction-associated steatotic liver disease (MASLD)
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a very common problem in which fat builds up in the liver. It is often linked to being overweight and conditions such as type 2 diabetes. MASLD can lead to long-term liver damage and other health issues, but making healthy lifestyle changes can stop or even reverse it.
What is MASLD?
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition where fat builds up in the liver. It occurs in people with other health conditions linked to how the body uses and stores energy, such as excess weight, type 2 diabetes, high blood pressure, or high cholesterol and triglycerides. The word “metabolic” refers to how your body uses and stores energy from the food you eat. MASLD was previously known as non-alcoholic fatty liver disease (NAFLD).
The good news is that MASLD can often be improved and sometimes even reversed. Losing weight (if needed), eating a healthy diet, and staying physically active can all reduce liver fat. For many people, these changes can stop the condition from worsening and may even reverse it.
Is MASLD common?
MASLD is very common and the number of people who have it is increasing. Overall, about one in five people in the UK have MASLD. It is even more common in people living with diabetes, especially type 2 diabetes. In the UK, around half to two-thirds of people living with type 2 diabetes also have MASLD.
What causes MASLD?
MASLD is most strongly linked to excess weight and type 2 diabetes. However, it can also develop in people who are a healthy weight if they have other risk factors. Things that can increase your risk of developing MASLD are:
Weight in the overweight or obese range
A high waist measurement
Type 2 diabetes
Unhealthy diet
Physical inactivity
High blood fats – cholesterol and triglycerides
High blood pressure
MASLD is also more common in:
Smokers
People of Hispanic ethnicity
People with obstructive sleep apnoea
Women with polycystic ovary syndrome
Women after menopause
Can MASLD be prevented?
If you are at risk of MASLD, good evidence shows you can prevent it by adopting a healthy lifestyle. This includes:
Eating a healthy diet
Being physically active
Losing weight, if you are within the overweight or obese range
Stopping smoking may also reduce the risk
Why does having MASLD matter?
MASLD can be linked to several types of health issues:
Liver problems
MASLD can irritate and damage liver cells. If this worsens, it is called metabolic dysfunction-associated steatohepatitis (MASH), previously known as non-alcoholic steatohepatitis (NASH). MASH can progress further by causing scarring of the liver and, in rare cases over many years, liver failure or liver cancer.
Circulatory problems
People with MASLD are at higher risk of:
Heart attacks
Strokes
Chronic (long-term) kidney disease
Metabolic problems
MASLD and metabolic issues often affect each other. People with MASLD are more likely to develop type 2 diabetes, and having MASLD can make type 2 diabetes more difficult to control. MASLD is also linked to:
High blood pressure
High blood fats (cholesterol or triglycerides)
What are the symptoms of MASLD?
Most people with MASLD or MASH do not have any symptoms. Some people may notice mild signs, such as:
Fatigue, tiredness or lethargy (although these are common and may not be related to MASLD)
A dull ache in the tummy (abdomen)
When to get help urgently
If you have any of the following symptoms, you should contact your healthcare team urgently as they may suggest more significant damage to the liver:
Yellowness in the eyes or skin (jaundice)
Swelling of the tummy (abdomen)
Black tarry poo
Very dark urine
Itchy skin over much of the body
How is MASLD diagnosed and monitored?
If your doctor suspects you may have a liver problem, they will first try to find the cause and check for any liver damage. This is done by:
Reviewing your medical history, including:
Other medical conditions
How much alcohol you drink
Medications (including anything you buy over the counter or online products)
Your diet
Physical activity levels
A physical examination
Blood tests
Imaging scans
Diagnosing MASLD can be difficult as often the tests don’t become positive until there has been significant damage to the liver.
Once MASLD is diagnosed, doctors will assess how likely it is to progress. This usually starts with blood tests and may be followed by scans if needed. How often someone needs follow-up depends on their risk of the condition worsening.
How is MASLD treated?
The aims of treatment of MASLD are to:
Stop or reverse any damage to the liver
Reduce the risk of related circulatory and metabolic problems
Currently, no medicines can specifically halt or reverse MASLD. However, strong evidence shows that adopting a healthy lifestyle can stop the condition from worsening and even help it improve.
What are the lifestyle changes to stop or reverse MASLD?
Weight management
You don’t need to achieve an ideal weight to improve MASLD. Losing 5% or more of your body weight can reduce fat buildup in the liver.
For example, if you weigh 100kg (15 stone 10 pounds), losing 5kg (about 11 pounds) can make a difference. If you have liver scarring, research suggests losing around 10% of your body weight may be more effective.
There isn’t one ‘right’ way to lose weight. What matters is finding an approach that feels manageable for you and that you can stick with over time.
If you are already at a healthy weight, avoid gaining extra weight, as it can make MASLD worse.
Read more about managing your weight
Diet
There is no single “best” diet or specific foods that you should eat. A balanced diet with a variety of healthy foods can help both manage weight and keep your liver healthy.
A good example is the “Mediterranean” style diet, which includes:
Vegetables
Olive oil
Nuts
Fish and lean meats
Some foods are best limited or avoided:
Saturated fat – found in foods such as red meat, processed foods (e.g. sausages and pies), butter, cheese, biscuits, cakes and pastries
Sugar-sweetened drinks or other sources of sugars
Eating a healthy diet matters for everyone, whether you're at a healthy weight or living with overweight or obesity.
Read more about healthy eating
Physical activity
All types of physical activity and exercise help to keep your liver and body healthy. You don’t need to go to the gym to benefit.
The key is to:
Reduce the amount of time you spend sitting or lying down
Choose activities you enjoy that get your heart beating faster and make you breathe a little harder
Everyday activities also count as physical activity, such as:
Carrying heavy shopping
Housework
Gardening
How much to aim for:
Try to be active for at least 150 minutes of moderate activity per week (for example, brisk walking, cycling, or swimming)
Include muscle-strengthening activities at least 2 days per week (e.g. carrying shopping, resistance exercises, or bodyweight exercises)
Break up long periods of sitting with short bouts of activity
Read more about how much physical activity is recommended
Alcohol
Drinking alcohol can damage the liver and increase fat in the liver. Avoiding alcohol altogether can help prevent MASLD.
If you choose to drink alcohol, it’s important to stick to the recommended limits:
Drink no more than 14 units of alcohol per week
Spread your alcohol intake across 3 or more days of the week
Have several alcohol-free days each week
If you have developed damage or scarring in your liver, your healthcare team may advise you to cut down or stop drinking completely.
Smoking
If you smoke, stopping can help improve MASLD and also reduces your risk of many other health issues, including:
Heart attacks and strokes
Long-term lung problems
Lung cancer and other cancers
Giving up smoking is hard but there are many support options available. NHS stop smoking services are free, friendly and can massively boost your chances of quitting for good.
Read more about programmes to help you give up smoking
What treatments might be needed for the linked circulatory and metabolic conditions?
The circulatory and metabolic problems associated with MASLD are closely linked. This means that treating the metabolic problems, such as high blood fats, diabetes and high blood pressure, will also reduce the risk of the circulatory issues, such as heart attacks and strokes.
Diabetes
Keeping blood glucose levels under control can prevent many health problems linked to diabetes, although it is not yet certain whether this also helps MASLD directly. Making small, healthy changes to your daily routine can have a big impact on your blood glucose levels.
You may also need medication. No single treatment improves both blood glucose and MASLD, although some diabetes medicines can also help with weight loss. Your healthcare team will discuss your options.
High blood fats
Your healthcare team will talk to you about your blood fat targets. Eating a healthy diet is very important for achieving good levels of cholesterol and triglyceride, but many people also need medication. The most common medications used to treat blood fats are statins. Statins are perfectly safe for people with MASLD or MASH and may even reduce the risk of developing liver damage.
High blood pressure
Your healthcare team will discuss the blood pressure targets that are right for you. Eating a healthy diet can make a big difference, but many people also need medication to keep their blood pressure well controlled.
Key message
MASLD is common and can cause long-term health problems, so it’s natural to feel worried if you’ve been diagnosed with it. The good news is that healthy lifestyle changes can prevent, improve, or stop MASLD from getting worse, even without specific medications. Related health conditions such as high blood pressure, type 2 diabetes and high levels of blood fats can also be treated successfully.
More information on MASLD can be found at MASLD, NAFLD and fatty liver disease – British Liver Trust.
MASLD only final (reviewed 30.8.26)