5 Surprising Things to Know About Fatty Liver Disease

One type, in particular, often goes missed — and it’s on the rise in the U.S.

Kimberly Goad,

Updated March 03, 2026

AARP

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Published May 06, 2022

/ Updated March 03, 2026

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A common — though commonly misunderstood — liver disease is on the rise, even among people who rarely reach for the bottle.

About 1 in 3 U.S. adults have metabolic dysfunction-associated steatotic liver disease (MASLD), a condition that occurs when abnormal amounts of fat build up in the liver. The disease used to be called nonalcoholic fatty liver disease (NAFLD) and was renamed in 2023 to reflect its ties with cardiometabolic health.

A 2025 report in Gastro Hep Advances showed that less than 1 percent know they have it.

Are you at risk?

A number of diseases and conditions raise your risk for MASLD. Here are a few.

High cholesterol
High levels of triglycerides (a type of fat) in the blood
Metabolic syndrome
Obesity, and especially if fat is concentrated in the abdomen
Polycystic ovary syndrome
Sleep apnea
Type 2 diabetes
Hypothyroidism
Hypopituitarism

Source: Mayo Clinic

“It's typically diagnosed as an incidental finding when patients are noted to have asymptomatic elevation of liver enzymes on routine laboratory tests or features of a fatty liver on abdominal imaging,” says Dr. Manal F. Abdelmalek, professor of medicine and director of the Hepatobiliary Disease Interest Group in the Division of Gastroenterology & Hepatology at the Mayo Clinic.Why the uptick in MASLD? Part of it has to do with the parallel increase in obesity, type 2 diabetes and high cholesterol — all risk factors for the condition, says Dr. Po-Hung (Victor) Chen, associate professor of medicine at the Johns Hopkins University School of Medicine. Research suggests that up to 75 percent of people who are overweight and more than 90 percent of people with obesity have MASLD. What’s more, up to 70 percent of people with type 2 diabetes have MASLD. And alcohol can also play a role in the progression of the disease.

“Even modest alcohol use in the presence of these metabolic risk factors [like obesity] can eventually injure the liver,” Chen says. Here are five surprising things you need to know about MASLD.

1. You can be a nondrinker and have MASLD

There are two types of liver disease that are caused by an abnormal buildup of fat in the liver. MASLD is the one not caused directly by alcohol consumption, even though alcohol use can aggravate it.

And while it’s true that you can live with a fatty liver, it’s also true that doing so raises your risk for type 2 diabetes and cardiovascular disease, both of which are linked to an increased risk for liver disease, Abdelmalek says. “Simple fatty liver does not disturb liver function; however, progressive liver injury and advanced [liver scarring] can impact liver function.”

2. Most people with MASLD don’t have significant liver damage

In about 15 to 20 percent of cases, however, the excess fat in the liver is accompanied by inflammation and damage to the liver’s cells, leading to an aggressive form of the disease called metabolic dysfunction-associated steatohepatitis (MASH, for short). With MASH, the liver damage is similar to the kind that’s caused by heavy alcohol use. There’s scarring of the liver (cirrhosis), liver cancer or liver failure.

If you have cardiovascular disease and/or type 2 diabetes, you’re more likely to have MASLD and MASH. On the flip side, if you have MASLD or MASH you are more likely to have cardiovascular disease and/or type 2 diabetes, the American Liver Foundation reports. Additionally, cardiovascular disease is the most common cause of death in people who have MASLD or MASH, the organization notes.

3. You can have MASLD without knowing it

People in the early stages of MASLD usually have no symptoms, and routine blood tests may not show anything amiss with the liver, Abdelmalek says. Complicating matters, elevated liver enzymes in the blood, a possible sign of MASLD, are often dismissed as a side effect of other medications or the result of recent alcohol consumption.

“The disease has no specific symptoms until the very late stages, which occur after decades, so the disease is often undetected unless the patient has abnormal liver tests or an abdominal ultrasound that demonstrates fat,” says Dr. Scott Friedman, director of the Institute for Liver Research at the Icahn School of Medicine at Mount Sinai.“ Physicians caring for patients with type 2 diabetes, hypertension or high blood lipids — especially if these patients are obese — should consider the possibility of underlying MASLD. Patients should also encourage their physicians to screen for this condition under these circumstances,” he adds.

MASLD can be diagnosed through standard blood tests for the liver, “combined with imaging that includes either ultrasound or a bedside test that can measure liver stiffness,” Friedman says. This test, known as Fibroscan or transient elastography, is now widely available in most liver specialists’ offices.

4. Women are at greater risk of MASLD as they age

Although researchers aren’t entirely sure why that is, they think the reason has to do with sex hormones. “Estrogens are protective against severe liver disease in premenopausal women,” Friedman says, echoing the results of a review of more than 60 studies published in the journal Endocrinology. “After menopause, however, the progression of liver disease accelerates and equals that of men the same age.”

That’s not to say that premenopausal women aren’t at risk of MASLD, cautions Friedman, “especially if multiple risk factors are present.”

5. Weight loss is the best prescription for MASLD

Yet another reason to get rid of extra weight: Research shows that losing at least 10 percent of body weight through a combination of diet and exercise can reverse MASH. (A Mediterranean-style diet is the only specific plan recommended by a consortium of professional groups for the treatment of MASLD and MASH.)

“As clichéd as it may sound, nothing beats addressing the metabolic risk factors through diet, exercise and weight loss,” Chen says. “It’s also essential to control diabetes and high cholesterol, with medications if necessary.”

Also key: avoiding alcohol. Although some research suggests that moderate drinking may reduce the risk of MASH and cardiovascular disease, studies show that any amount of alcohol can aggravate MASLD and interfere with the liver’s ability to heal.

Beyond lifestyle changes, there are no treatments for MASLD, but “given the precipitous rise in prevalence of MASLD, there has been an intense effort for the past five to 10 years to understand the disease better and uncover targets for treatment,” Friedman explains. There are currently more than 100 drugs in clinical trials for this condition. And although none have been approved by the Food and Drug Administration, Friedman says, “We’re getting much closer every day.”

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.