Fatty Liver Disease: Symptoms, Causes and How to Reverse It

Fatty Liver Disease: Symptoms, Causes and How to Reverse It

Fatty liver disease, now called MASLD (metabolic dysfunction-associated steatotic liver disease, formerly NAFLD), means extra fat has built up in your liver, usually alongside excess weight, type 2 diabetes, high blood pressure or high blood fats. It often causes no symptoms at all, and in its early stages it can often be reversed. Losing as little as 3% to 5% of your body weight can cut liver fat, and losing 7% to 10% may reduce inflammation and scarring, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

This article is for general information and is not medical advice.

Key takeaways

  • MASLD is fat buildup in the liver linked to metabolic health, not heavy drinking. About 1 in 4 adults worldwide has it.
  • Most people feel nothing. When symptoms appear, they are usually tiredness or discomfort in the upper right belly.
  • The more serious form, MASH, adds inflammation and liver damage and can lead to scarring, cirrhosis and liver cancer.
  • Gradual weight loss, regular exercise and a healthier diet are the main treatment. Two medicines are now FDA approved for MASH with moderate to advanced scarring.
  • Simple blood tests and a liver stiffness scan can show whether you have significant scarring, often without a biopsy.

What is fatty liver disease?

Fatty liver disease is a condition where more than 5% of your liver is made up of fat. When that fat comes with at least one metabolic risk factor, such as higher body weight, type 2 diabetes, high blood pressure or abnormal blood lipids, doctors call it MASLD.

The name changed in 2023. You may still see older terms in test reports or online, so here is how they line up:

  • NAFLD (nonalcoholic fatty liver disease) is now MASLD.
  • NAFL (simple fatty liver, with little or no inflammation) is now MASL.
  • NASH (nonalcoholic steatohepatitis) is now MASH, short for metabolic dysfunction-associated steatohepatitis. "Steatohepatitis" simply means a fatty liver that is also inflamed.

It is very common. MedlinePlus estimates that about 25% of adults and 7% to 14% of children worldwide have MASLD, and up to 30% of people with MASLD go on to develop MASH. In the United States, the FDA says about 6% of adults, or 14.9 million people, have MASH.

Fatty liver disease often travels with other conditions that share the same roots. If you have read about metabolic syndrome and how to reverse it, much of that advice applies directly to your liver.

What are the symptoms of fatty liver disease?

Most people with fatty liver disease have no symptoms, especially in the early stages. That is why it is often called a silent disease.

When early symptoms do show up, Cleveland Clinic notes they tend to be vague:

  • Tiredness or feeling generally unwell
  • A dull ache or discomfort in the upper right side of your abdomen, where the liver sits

As the disease progresses to MASH or cirrhosis, Cleveland Clinic lists signs such as a swollen belly, swelling in the legs and yellowing of the skin and eyes (jaundice).

Because symptoms are so easy to miss, many people only find out when a routine blood test shows raised liver enzymes or an ultrasound done for another reason shows a fatty liver.

What causes fatty liver disease and who is at risk?

Fatty liver disease is driven mainly by excess weight and insulin resistance, a state where your body does not respond well to insulin, so more fat is stored in the liver. Experts still do not fully understand why some people develop it and others with the same risks do not.

According to Cleveland Clinic and MedlinePlus, your risk is higher if you have:

  • Overweight or obesity, especially extra fat around the waist
  • Insulin resistance, prediabetes or type 2 diabetes
  • High triglycerides or abnormal cholesterol
  • High blood pressure
  • Older age, though children can also be affected

The numbers are striking. MedlinePlus reports that MASLD affects up to 75% of adults with obesity or high blood lipids and up to 65% of adults with type 2 diabetes. If you have noticed early signs of diabetes, ask your doctor to check your liver as well.

Genes play a part. MedlinePlus Genetics notes that a variant in the PNPLA3 gene makes the liver hold on to fat and break it down more slowly, which can explain why some lean people still develop the condition. Diet matters too: a diet high in cholesterol and refined sugars has been linked to higher risk, and differences in gut bacteria may also play a role.

Before diagnosing MASLD, your doctor will look for other causes of liver fat and raised liver enzymes, such as heavy alcohol use or viral hepatitis. Drinking can also add to the damage in a liver that is already fatty, which is one reason to understand how alcohol affects long-term health.

What are the stages of fatty liver disease?

Fatty liver disease moves through four broad stages, from simple fat buildup to cirrhosis. Most people stay in the first stage, and the earlier stages respond best to lifestyle change.

StageWhat is happeningCan it improve?
1. Simple fatty liver (MASL)Fat in the liver with little or no inflammation. Usually causes no liver complications.Yes. Weight loss of 3% to 5% can reduce liver fat.
2. MASHFat plus inflammation and damage to liver cells.Often. Weight loss of 7% to 10% may reduce inflammation.
3. FibrosisScar tissue starts to form as the liver tries to repair ongoing injury.Sometimes. The same 7% to 10% weight loss may reduce fibrosis, and two medicines are approved for moderate to advanced fibrosis.
4. CirrhosisSevere scarring replaces healthy tissue and the liver cannot work normally.Damage is harder to undo. Treatment focuses on preventing complications. A transplant may be needed for liver failure.

Cirrhosis can lead to fluid buildup in the belly, confusion or trouble thinking clearly, liver cancer and liver failure, according to Cleveland Clinic. People at any stage of MASLD have a higher risk of liver cancer than people without it.

How is fatty liver disease diagnosed?

Fatty liver disease is usually diagnosed with blood tests and imaging, and a liver biopsy is only needed in some cases. The main goal is to find out whether you have scarring, because that predicts how serious the disease is.

The NIDDK diagnosis guide describes the usual steps:

  1. Blood tests. Raised levels of the liver enzymes ALT and AST can be the first clue. Your doctor will also run tests to rule out other causes, such as viral hepatitis.
  2. A fibrosis score. Results from routine blood tests, plus your age, can be plugged into a formula called the FIB-4 index (or the similar APRI score). A low score makes advanced scarring unlikely.
  3. Imaging. Ultrasound, CT or MRI can show fat in the liver, but they cannot tell simple fatty liver from MASH.
  4. Elastography. This painless scan measures how stiff your liver is. Stiffer tissue suggests scarring. It can be done with ultrasound (transient or shear wave elastography) or MRI (magnetic resonance elastography).
  5. Liver biopsy, if needed. A small sample of liver tissue is examined under a microscope. It is the only test that can confirm MASH and show how severe it is, and it is usually reserved for people whose other tests suggest advanced disease.

How can you reverse fatty liver disease with weight loss and lifestyle?

Gradual weight loss is the most effective way to reverse fatty liver disease. Losing at least 3% to 5% of your body weight can reduce liver fat, and losing 7% to 10% may reduce inflammation and scarring, according to NIDDK.

For someone who weighs 200 pounds, that means about 6 to 10 pounds to start lowering liver fat, and about 14 to 20 pounds to help the inflamed, scarred liver. Here is what helps most:

  • Lose weight slowly. NIDDK warns that rapid weight loss and malnutrition can make liver disease worse.
  • Move most days. Physical activity helps your liver even if the scale does not change much.
  • Eat a Mediterranean-style diet. Cleveland Clinic recommends a Mediterranean-style eating pattern, which centers on vegetables, fruits, whole grains and healthy fats.
  • Cut sugary drinks and refined sugars. Diets high in refined sugars are linked to a higher risk of MASLD.
  • Limit alcohol. Even moderate drinking adds stress to a liver that is already under strain.
  • Treat related conditions. Keeping blood sugar, blood pressure and cholesterol under control lowers your overall health risks.

If you were told you have prediabetes despite a healthy lifestyle, a liver check is worth discussing, since fat stored in the liver can be part of the same picture.

Are there medicines for fatty liver disease?

Yes, for people with MASH and significant scarring. In March 2024 the FDA approved resmetirom, a daily pill, for adults with MASH and moderate to advanced fibrosis who do not have cirrhosis. It is used together with diet and exercise. Common side effects are diarrhea and nausea, and it can interact with some statins.

In August 2025 the FDA also approved semaglutide, a weekly injection, for adults with MASH and moderate to advanced fibrosis. Semaglutide belongs to a class covered in our guide to GLP-1 weight-loss drugs. Common side effects include nausea, diarrhea, vomiting and constipation.

Neither medicine replaces lifestyle change, and neither is meant for simple fatty liver without scarring.

Common mistakes to avoid with fatty liver disease

  • Assuming no symptoms means no problem. Scarring can build silently for years.
  • Crash dieting. Very fast weight loss can harm the liver. Aim for steady, sustainable change.
  • Taking "liver detox" supplements or herbal remedies. NIDDK advises talking to your doctor first, because some supplements can damage the liver.
  • Thinking only heavy drinkers get liver disease. MASLD is driven by metabolic health, and lean people can have it too.
  • Ignoring your heart. MASLD shares risk factors with heart disease and diabetes, two of the most common chronic diseases, so treat the whole picture.
  • Stopping once your enzymes look normal. Normal ALT does not rule out scarring. Follow up on fibrosis testing as your doctor advises.

When to see a doctor

See a doctor for a liver check if you have type 2 diabetes, obesity or two or more metabolic risk factors, even if you feel fine. Get prompt care if you notice any of these red flags:

  • Yellowing of your skin or the whites of your eyes
  • A swollen or tight belly, or swelling in your legs and ankles
  • Vomiting blood or passing black, tarry stools (seek emergency care)
  • New confusion, drowsiness or slurred speech
  • Ongoing pain in the upper right abdomen
  • Unexplained weight loss, easy bruising or bleeding

FAQ

Can fatty liver disease be reversed?

Often, yes. In the early stages, losing 3% to 5% of your body weight can reduce liver fat, and 7% to 10% may reduce inflammation and scarring. Cirrhosis is much harder to undo, which is why early action matters.

How long does it take to reverse a fatty liver?

It depends on how much fat and scarring you have and how quickly you lose weight safely. Liver fat can start to fall within months of steady weight loss, while scarring takes longer to improve. Your doctor can track progress with repeat blood tests or a liver stiffness scan.

Is MASLD the same as NAFLD?

Mostly. MASLD is the newer name for NAFLD, adopted in 2023. It focuses on the metabolic causes, such as excess weight and insulin resistance, rather than on the absence of alcohol use.

Can thin people get fatty liver disease?

Yes. Genetic variants such as PNPLA3, insulin resistance and a diet high in refined sugars can cause fat to build up in the liver even at a normal weight.

What to do next

  1. Ask your doctor whether your liver enzymes and a FIB-4 score have been checked, especially if you have diabetes or obesity.
  2. Set a realistic goal of losing 5% to 10% of your body weight over several months.
  3. Build in at least some physical activity most days, and swap sugary drinks for water.
  4. Cut back on alcohol and check any supplements with your doctor.
  5. If you have MASH with scarring, ask whether a medicine approved for this condition is right for you.

Sources

Last reviewed: November 2026.

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