Fatty Liver Disease (MASLD): The Common Condition Most People Have Never Heard Of

Here’s a condition that affects roughly one in three American adults, can lead to cirrhosis and liver cancer, is closely tied to heart disease, and that most people have never heard of.

It’s called MASLD, short for metabolic dysfunction-associated steatotic liver disease. You may know it by its old name: non-alcoholic fatty liver disease, or NAFLD.

What is MASLD?

MASLD means excess fat has built up in the liver, driven by metabolic factors rather than heavy alcohol use. It’s strongly linked to:

• Excess weight, especially around the abdomen
• Prediabetes and type 2 diabetes
• High triglycerides or low HDL cholesterol
• High blood pressure

In 2023, liver specialists renamed the condition to reflect what really causes it (metabolic dysfunction) and to move away from defining it by what it isn’t (alcohol).

Why it matters

For many people, fatty liver stays relatively stable. But in a meaningful portion of patients, it progresses:

1. Simple fatty liver (steatosis): fat in the liver
2. MASH (metabolic dysfunction-associated steatohepatitis): fat plus inflammation and liver cell injury
3. Fibrosis: scarring that builds up over time
4. Cirrhosis: advanced scarring that can lead to liver failure and liver cancer

MASLD is becoming one of the leading reasons people need liver transplants in the United States.

And there’s a twist: the most common cause of death in people with fatty liver disease isn’t liver disease. It’s heart disease. The same metabolic problems that put fat in the liver also damage the arteries. Finding MASLD is a signal to look carefully at your cardiovascular risk as well.

Why so few people know they have it

MASLD usually causes no symptoms until it’s advanced. Some people notice fatigue or a vague ache in the upper right abdomen, but most feel fine.

It’s often discovered by accident:

• Mildly elevated liver enzymes (ALT or AST) on routine blood work
• “Fatty liver” noted on an ultrasound or CT scan done for another reason

Importantly, normal liver enzymes don’t rule it out. Many people with significant fatty liver have normal blood tests.

How we evaluate fatty liver

If you have risk factors such as obesity, prediabetes or diabetes, or metabolic syndrome, or fatty liver has been noted on imaging, we’ll check for it. The key question isn’t just “is there fat in the liver?” but “is there scarring?” Scarring (fibrosis) is what predicts future problems.

1. Blood tests to check liver function and rule out other causes, such as viral hepatitis, iron overload, autoimmune disease, and medications.
2. FIB-4 score, a simple calculation using your age and routine lab values that estimates the risk of significant scarring.
3. Elastography (such as FibroScan), a painless, ultrasound-based test that measures liver stiffness, if the FIB-4 isn’t reassuring.
4. Referral to a liver specialist when testing suggests advanced scarring.

Most people never need a liver biopsy.

Treatment: weight loss works

The most effective treatment for MASLD is weight loss, and the benefits follow a clear dose-response pattern:

• About 5% weight loss reduces liver fat.
• About 7 to 10% can resolve the inflammation of MASH.
• 10% or more can actually improve liver scarring.

That’s where modern obesity medicine has changed the picture.

New medications for fatty liver

For years, there were no FDA-approved medications for fatty liver disease. That has changed:

• Rezdiffra (resmetirom) was approved in 2024 as the first drug for MASH with moderate to advanced scarring. It acts directly on the liver.
• Wegovy (semaglutide) was approved in August 2025 for MASH with moderate to advanced scarring. In the ESSENCE trial, 63% of patients on semaglutide had resolution of liver inflammation without worsening scarring, and 37% had improvement in scarring, compared with much lower rates on placebo.
• Tirzepatide (Zepbound) has shown strong results in earlier-stage MASH studies, and larger trials are underway.

For patients with obesity and fatty liver, GLP-1 medications are especially appealing because they address the liver, weight, blood sugar, and cardiovascular risk at the same time.

Everyday steps that help your liver

• Lose weight if you’re carrying extra. Even modest amounts help.
• Limit or avoid alcohol. Alcohol and metabolic fatty liver together do more damage than either alone.
• Cut back on sugary drinks and refined carbohydrates, which drive liver fat.
• Stay active. Exercise reduces liver fat even without major weight loss.
• Manage diabetes, cholesterol, and blood pressure.
• Get vaccinated against hepatitis A and B if you’re not already immune.
• Coffee has been associated with better liver health in many studies. If you already drink it, there’s no need to stop.

Fatty liver care in Spokane

At Aristos Internal Medicine, screening for fatty liver disease is part of every thorough metabolic evaluation. Because I’m board certified in both Internal Medicine and Obesity Medicine, we can evaluate your liver, treat the underlying metabolic causes, and manage related conditions like prediabetes and diabetes all in one place. Learn more about our obesity and metabolic health services.

If you’ve been told you have fatty liver, or you have risk factors and have never been checked, schedule an appointment online or call (509) 426-5425. We see patients in Spokane and by virtual visit throughout Washington.