Fatty Liver (MASLD)
Extra fat stored in the liver, usually found by accident on a blood test or scan. Common, mostly silent and, in the early stages, reversible. The treatment is unglamorous: weight, movement and less alcohol.
What it is: MASLD (metabolic dysfunction-associated steatotic liver disease) is the new name for NAFLD. It affects up to 1 in 5 people in the UK, and travels with obesity, type 2 diabetes and heart disease.
Why it matters: it can progress from fat, to inflammation, to scarring (cirrhosis) and rarely liver cancer. Fat and inflammation can reverse; cirrhosis can’t. It also raises the risk of diabetes and heart disease, and the risk runs both ways.
Tests: liver blood tests, an ultrasound and often a FibroScan, a painless scan that measures liver stiffness to check for scarring. A biopsy is only for selected cases. Most people have no symptoms.
The fatty liver ladder
Weight is the dial. Lose 7–10% and liver damage may reverse; more than 10% can clear the fat and inflammation.
- Step 1 · Self-careLose some weight, slowlyA gradual loss through eating changes you can keep up.
- Works
- 7–10% weight loss may reverse liver damage; over 10% can remove liver fat and inflammation. Even at a healthy weight, losing 3–5% is advised
- Cost
- Free
- How long
- Months; about 0.5–1 kg a week
- Watch for
- Crash diets: avoid them.
Your liver is very forgiving, up to a point.
- Step 2 · Self-careMove: 150 minutes plus strength150 minutes of moderate or 75 minutes of vigorous activity a week, spread over most days, with strength work on 2 days.
- Works
- Recommended for everyone with MASLD; helps weight, blood sugar and heart risk
- Cost
- Free to low cost
- How long
- Ongoing
- Watch for
- Long sitting spells count against you; get up and move often.
The liver doesn’t care whether it’s a gym or a dog walk.
- Step 3 · Self-careMediterranean-style eatingPlenty of plants, olive oil, oily fish, fewer ultra-processed foods and sugary drinks, less red meat.
- Works
- Shown to help liver inflammation
- Cost
- Free, or a different shopping list
- How long
- Ongoing
- Watch for
- Fruit juice counts as a sugary drink.
More olive oil, fewer things in crinkly packets.
- Step 4 · Self-careLess alcohol, ideally noneAlcohol adds a second hit to the same liver.
- Works
- Liver clinics advise avoiding alcohol where possible, and staying within low-risk limits if you drink
- Cost
- Saves money
- How long
- Ongoing
- Watch for
- If scarring is present, your doctor may advise none at all.
One liver, two problems. Don’t give it a third.
- Step 5 · PrescriptionTreat the company it keepsBlood pressure, cholesterol and diabetes treatment, and weight-loss medicines if eligible.
- Works
- Important because MASLD travels with diabetes and heart disease
- Cost
- Mostly under the $25 PBS co-payment
- How long
- Long term
- Watch for
- Regular checks of blood pressure, blood sugar and cholesterol.
The liver is the headline. The heart is often the bigger story.
- Step 6 · SpecialistLiver specialistIf tests suggest scarring, or blood tests stay abnormal.
- Works
- Monitoring and specialist care for advanced scarring
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- Long term
- Watch for
- Usually only needed for a minority.
Most people manage this with their GP.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Liver “detoxes” and cleansesNo good evidence they treat fatty liver. Your liver is the detox.
- Crash dietsLiver clinics advise against them. Slow, steady loss is what reverses fat.
- Fruit juices and “healthy” smoothiesThey count as sugary drinks, which you’re advised to cut.
What you can do
- Aim for 7–10% weight loss if you’re above a healthy weight.
- Walk most days and add 2 strength sessions a week.
- Swap sugary drinks and juice for water.
- Cut back alcohol, ideally to none.
- Ask your GP to check your blood pressure, blood sugar and cholesterol.
See your GP if
- Your liver blood tests are abnormal
- You have type 2 diabetes or obesity and have never had your liver checked
- You feel tired with poor appetite, nausea or tummy pain
See a doctor promptly if your skin or the whites of your eyes turn yellow, your urine goes dark, or your tummy swells. These can be signs of advanced liver disease.
Common questions
Is fatty liver reversible?
In the early stages, yes. Losing 7 to 10% of body weight may reverse liver damage, and more than 10% can remove liver fat and inflammation. Scarring that has become cirrhosis does not reverse.
What is the difference between MASLD and NAFLD?
It is the same condition with a new name. MASLD stands for metabolic dysfunction-associated steatotic liver disease, reflecting its links with weight, blood sugar and heart disease.
Can I still drink alcohol with fatty liver?
It is best to avoid alcohol where possible. If you drink, stay within low-risk limits, and ask your doctor, as some people with scarring should not drink at all.
Do I need a liver biopsy?
Usually not. Blood tests, an ultrasound and a FibroScan are the usual tests. A biopsy is only for selected cases.
Helpful resources
- Bradford Teaching Hospitals NHS: MASLDPractical liver-clinic guide to weight, activity, diet and alcohol. Free, UK.
- Weight and obesity fact sheetRealistic targets and the treatments that work. Free, from us.
Evidence and more information
maladywise.com/fatty-liver/