Fatty Liver Disease (MASLD – Metabolic Dysfunction Associated Steatotic Liver Disease)

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What is Fatty Liver Disease (MASLD)?

Metabolic dysfunction associated steatotic liver disease (MASLD), previously known as fatty liver disease, is a condition where excess fat accumulates in the liver in people with metabolic risk factors. MASLD is now the preferred medical term and reflects the strong link between liver fat and metabolic health.

MASLD is common in Australia and is often associated with overweight or obesity, type 2 diabetes, high cholesterol, and high blood pressure. Many people with MASLD have no symptoms, particularly in the early stages.

2. Causes & Risk Factors

MASLD develops as part of a broader metabolic condition rather than from alcohol intake. It is closely linked to insulin resistance and abnormal fat metabolism.

Risk factors include excess weight (especially central obesity), type 2 diabetes, pre-diabetes, high cholesterol or triglycerides, high blood pressure, sedentary lifestyle, and genetic predisposition. Alcohol intake can worsen liver injury even if it is not the primary cause.

3. Symptoms & How It May Present

Most people with MASLD have no symptoms and are diagnosed incidentally on blood tests or imaging.

When symptoms occur, they may include fatigue, mild discomfort in the right upper abdomen, or general malaise. In more advanced disease, inflammation and scarring of the liver can occur, which may progress to cirrhosis over time.

4. How Is It Diagnosed?

Diagnosis is based on clinical assessment, blood tests, and imaging. Liver function tests may show abnormal enzymes, although normal blood tests do not exclude MASLD.

Ultrasound is commonly used to detect liver fat. Non-invasive tests such as FibroScan or specialised blood tests may be used to assess liver stiffness and fibrosis risk. In selected cases, a liver biopsy may be required.

5. Treatment & Management Options

The cornerstone of MASLD management is improving metabolic health. Weight loss through diet and physical activity is the most effective treatment.

Even modest weight loss can significantly reduce liver fat and inflammation. Management of diabetes, cholesterol, and blood pressure is essential. There are currently no medications specifically approved for MASLD, but some medications may be used in selected patients under specialist care. Importantly, people with MASLD have a significantly increased risk of cardiovascular disease, which is the leading cause of death in this condition. Managing MASLD therefore goes beyond liver health and requires careful attention to heart health, blood pressure, cholesterol, and diabetes.

6. Living With / Managing MASLD

MASLD is often reversible, particularly when identified early. Long-term outcomes depend on controlling metabolic risk factors and preventing progression to fibrosis.

Regular follow-up, blood tests, and non-invasive liver assessments may be recommended. Avoiding excess alcohol, maintaining physical activity, and following a sustainable healthy eating plan are key to long-term liver health. Effective management usually requires a multidisciplinary approach. This often includes support from dietitians to achieve sustainable weight loss, exercise physiologists to improve physical activity and insulin sensitivity, and medical specialists to optimise metabolic risk factors.

7. Prevention & Risk Reduction

Maintaining a healthy weight, engaging in regular physical activity, and managing metabolic conditions such as diabetes and high cholesterol can reduce the risk of developing MASLD.

Early identification and lifestyle intervention are the most effective strategies to prevent progression to advanced liver disease.

8. When to Seek Medical Advice

You should seek medical advice if liver blood tests are persistently abnormal, imaging shows fatty liver, or if you have risk factors such as diabetes or obesity.

Urgent review is recommended if you develop symptoms of advanced liver disease, including jaundice, abdominal swelling, leg swelling, confusion, or unexplained bleeding.