Fatty Liver Disease

What is fatty liver disease (MASLD/MASH)?

Fatty liver disease happens when fat builds up in your liver and makes it harder for your liver to work correctly. It can lead to inflammation, scarring and liver damage. If more than 5% to 10% of your liver’s weight is fat, it may be considered fatty.

Fatty liver disease related to your metabolic health is called metabolic dysfunction associated steatotic liver disease (MASLD).

When MASLD causes liver inflammation and harms your liver, it is considered a more severe type of fatty liver disease, called metabolic dysfunction associated steatohepatitis (MASH). MASH increases your risk of cirrhosis, liver failure, liver cancer and early death.

In the past these conditions were called nonalcoholic fatty liver disease (NAFLD), nonalcoholic fatty liver and nonalcoholic steatohepatitis (NASH).

MASLD and MASH are not caused by alcohol use. They are different from alcohol-related fatty liver disease.

Learn more about alcohol-associated liver disease.

Causes and risk factors

Fatty liver disease is closely linked to metabolic health.

Common causes include:

• Insulin resistance
• Too much fat being stored in the liver
• Chronic inflammation because of metabolic conditions

Risk factors may include:

• Overweight or obesity, especially when extra weight is around the belly
• Type 2 diabetes or prediabetes
• High cholesterol or triglycerides
• High blood pressure
• Metabolic syndrome
• Polycystic ovary syndrome
• Obstructive sleep apnea
• Certain thyroid conditions
• Some medications
• Family history of fatty liver disease
• Sedentary lifestyle
• Older age, although children, teens and adults of any age can develop it
• Hispanic or Caucasian background

Not everyone with these risk factors develops liver damage and some people develop MASLD even without having risk factors.

Signs and symptoms

Many people with MASLD have few or no symptoms, especially in the early stages. If symptoms appear, they may include:

• Fatigue
• Mild discomfort in the upper right abdomen
• Generally feeling unwell

Symptoms of more advanced disease may include:

• Unexplained weight loss
• Weakness
• Yellowing of the skin or eyes (jaundice)
• Swelling in the belly or legs
• Shortness of breath
• Itching
• Spiderlike blood vessels on the skin
• Enlarged spleen
• Change in color on the palms
• Muscle wasting
• Confusion
• Sleepiness

How it’s diagnosed

Because symptoms are often mild, fatty liver disease is often found during routine blood tests or imaging tests.

A health care provider may recommend screening for fatty liver disease based on your medical history and risk factors. They may check for physical signs of an enlarged liver. 

Tests like these can diagnose the type of fatty liver disease and see how much liver damage there is:

• Blood tests to check liver enzymes
• Imaging tests such as ultrasound, CT or MRI
• Specialized imaging tests to measure fat and stiffness of the liver tissue, such as FibroScan or MR elastography
• Liver biopsy in select cases to check for inflammation and scarring

These tests help show whether you have MASLD or MASH and how advanced the disease is.

Treatment and care

Treatment for fatty liver disease aims at improving your metabolic health and protecting your liver.

These lifestyle changes and preventive care steps can help lower your risk of severe liver problems:

• Gradual weight loss if you need to lose weight, since losing 7% to 10% of your body weight may reduce liver fat, inflammation and scarring 
• Eating a healthy diet such as a Mediterranean diet, with plenty of fruits, vegetables, whole grains and healthy fats and fewer added sugars and refined carbohydrates
• Getting enough physical activity
• Managing diabetes, cholesterol and high blood pressure
• Avoiding alcohol and unnecessary medications
• Regularly monitoring your liver health
• Getting vaccinated against hepatitis A and B, influenza and pneumococcal disease, to lower the risk of serious infections
• Talking with your provider before you take vitamins, herbal remedies or other supplements, since some can harm your liver

To treat MASH, your provider may recommend a medication called resmetirom (Rezdiffra) or certain diabetes medications, including semaglutide (Wegovy) depending on the degree of scarring in your liver.

Complications and advanced disease

MASLD doesn’t always develop into advanced liver disease. It’s more likely to get worse if you have obesity, type 2 diabetes and metabolic syndrome. If MASLD progresses to MASH, it can increase your risk of:

• Liver fibrosis or scarring
• Cirrhosis
• Liver failure and need for a liver transplant 
• Liver cancer
• Heart disease

Early diagnosis and lifestyle changes can help slow or stop fatty liver disease and lower the risk of complications.

When to talk to a specialist

Specialty care can help, especially if you have inflammation or scarring or you’re at risk for MASLD or MASH getting worse. Your provider may refer you to a gastroenterologist (digestive system specialist) or hepatologist (liver specialist) if:

• Your liver blood tests stay abnormal
• Imaging shows liver scarring
• Symptoms suggest that you might have advanced liver disease
• You have several metabolic risk factors

Specialist care can help guide your treatment, monitor your liver health and watch for signs of complications and liver cancer.

You may need close monitoring if you have MASLD and you are pregnant or planning to become pregnant, since MASLD can increase the risk of gestational diabetes, preeclampsia, preterm birth and other complications for both mother and baby.

Find care at Banner Health

At Banner Health, we offer comprehensive care for fatty liver disease, including MASLD and MASH. Our specialists include primary care providers, liver specialists, dietitians, weight management specialists and behavioral health providers to help you make and stick to long-term lifestyle changes.

We work with you to improve your metabolic health, reach and maintain a healthy weight, monitor your liver function and manage any advanced liver conditions. Find a Banner Health liver specialist near you.