Why the new name?
In 2023, international liver societies agreed on new terms:
- MASLD: fatty liver plus at least one metabolic risk factor (see below).
- MASH: MASLD with inflammation and liver cell injury (previously NASH).
- MetALD: MASLD in people who also drink more alcohol than low-risk amounts.
The new name focuses on the cause (metabolic dysfunction) and drops terms some patients found stigmatising.
Who gets MASLD?
You have MASLD if there is fat in your liver and at least one of these cardiometabolic risk factors:
| Risk factor | Threshold |
|---|---|
| Body size | BMI 25 or more, or waist above 94 cm (men) or 80 cm (women) |
| Blood sugar | Fasting glucose 5.6 mmol/L or more, HbA1c 5.7% or more, or type 2 diabetes |
| Blood pressure | 130/85 mmHg or more, or on treatment |
| Triglycerides | 1.7 mmol/L or more, or on treatment |
| HDL cholesterol | 1.0 mmol/L or less (men), 1.3 mmol/L or less (women), or on treatment |
People with type 2 diabetes or obesity are at particularly high risk of the more serious forms.
Symptoms
Usually none. Some people notice tiredness or mild discomfort in the upper right abdomen, but most cases are found by chance on blood tests or an ultrasound done for another reason.
How is it checked?
- Blood tests. Liver enzymes (such as ALT) may be raised, but normal liver tests do not rule out fatty liver.
- Ultrasound can show fat in the liver.
- Scarring (fibrosis) risk. European guidelines (2024) recommend that people at risk start with a simple score called FIB-4, calculated from age and routine blood results. If it isn't clearly low, the next step is usually a liver stiffness scan (elastography), a quick, painless ultrasound-type test. A biopsy is rarely needed.
Scarring, not fat itself, is the main thing that predicts long-term liver problems, which is why this assessment matters.
What helps?
Weight loss, if you carry excess weight
According to the 2024 European guidelines (EASL, EASD and EASO):
| Sustained weight loss | Typical effect on the liver |
|---|---|
| 5% or more | Reduces liver fat |
| 7% to 10% | Improves liver inflammation |
| 10% or more | Can improve scarring (fibrosis) |
For someone weighing 90 kg, 5% is about 4.5 kg. Gradual, sustainable change is the goal.
Other steps
- Move regularly. Physical activity reduces liver fat even with little weight change.
- Eat a Mediterranean-style pattern: vegetables, legumes, whole grains, olive oil, fish and nuts; fewer sugary drinks and ultra-processed foods.
- Limit alcohol. The guidelines state that there is no safe or protective level of alcohol for people with MASLD.
- Look after your heart. People with MASLD are more likely to die of heart disease than of liver disease, so blood pressure, cholesterol, blood sugar and smoking all matter.
Medicines for MASH and related conditions are developing quickly. Whether any is right for you depends on your overall picture and is a decision for you and your doctor.
When to see a doctor
See your doctor if you:
- have been told you have a fatty liver on a scan;
- have type 2 diabetes, obesity, or two or more metabolic risk factors;
- have raised liver tests.
Seek urgent care for yellowing of the skin or eyes, vomiting blood, black stools, a swollen abdomen or confusion.
Frequently asked questions
Is fatty liver reversible?
Often, yes. Liver fat can fall significantly with weight loss and activity, and even early scarring can improve.
Can slim people have fatty liver?
Yes. It can occur at a "normal" weight, often with fat around the abdominal organs or other metabolic risk factors.
Is a little alcohol good for my liver?
No. Current guidelines say alcohol does not protect the liver in MASLD, and less is better.
Does fatty liver always lead to cirrhosis?
No. Most people do not progress to cirrhosis. Assessing scarring helps identify the minority who need closer follow-up.
References
- American Association for the Study of Liver Diseases (AASLD). New MASLD nomenclature. 2023. https://www.aasld.org/new-nafld-nomenclature
- European Association for the Study of the Liver (EASL), EASD and EASO. Clinical Practice Guidelines on the management of MASLD. Diabetologia. 2024. https://air.unimi.it/retrieve/0a880a86-ba08-4c65-b360-8e3c6f92a121/s00125-024-06196-3.pdf
- Rinella ME et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology. 2023.
This article is for general educational purposes only, like a health newsletter. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor and patient relationship. Please speak to your own doctor about your situation. In an emergency, call 10177 or 112, or go to your nearest emergency unit.