4 Ways to Reverse Metabolic Dysfunction-Associated Steatotic Disease

About 1 in 3 U.S. adults have this often symptomless condition in the liver

Kimberly Goad,

Updated March 02, 2026

AARP

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Published May 24, 2023

/ Updated March 02, 2026

Fatty liver disease and hepatic steatosis rendering

wildpixel / Getty Images

Metabolic dysfunction-associated steatotic liver disease (MASLD) might just be the most common disease you’ve never heard of.

The condition, which occurs when excess fat accumulates in the liver of a person who isn’t a heavy drinker, is the most common form of chronic liver disease, affecting roughly 34 percent of U.S. adults as of 2020 (and expected to affect 41.4 percent by 2050). Still, it isn’t on most people’s radar, even after its name was changed from nonalcoholic fatty liver disease in 2023.

“The biggest problem is low awareness among primary care doctors,” says Dr. Mary Rinella, a professor of medicine and the director of the Metabolic and Fatty Liver Disease Clinic at University of Chicago Medicine.

Indeed, research suggests primary care doctors aren’t always certain which patients to screen for MASLD. (Why test your teetotaling patients for a liver disease?)

Further complicating matters: Those who have the condition typically experience few, if any, symptoms. (How can you talk to your doctor about a condition you don’t even suspect you have?)

“It’s a common myth that only alcohol can damage the liver or cause scarring — also known as cirrhosis — but the truth is that fat buildup is a major cause of liver damage and can lead to liver failure and its most feared complication, liver cancer,” says Dr. Ani Kardashian.

“In fact, fatty liver is the second most common reason for liver transplants in the U.S.,” says Kardashian, who is an assistant professor of medicine in the division of gastroenterology and liver diseases at the Keck School of Medicine at the University of Southern California.

It’s normal for the liver to have some fat, but if more than 5 to 10 percent of your liver’s weight is fat, you have what’s known as a fatty liver. With MASLD, fatty liver happens in people who aren’t heavy drinkers.

The risk of MASLD is higher for people over age 50, particularly women.

“As adults age, they are more likely to develop high blood pressure, diabetes, high cholesterol or obesity, which are the principal risk factors for fatty liver,” Kardashian says. “In women, menopause is an additional hit. Estrogen is protective against fatty liver and liver scarring … and after women hit menopause, as estrogen levels drop, they lose that protective effect.”

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While there is no cure for MASLD, it can be reversed; at the least you can take steps to control the amount of fat in your liver. The longer it goes undiagnosed, however, the greater the chances of progressing to metabolic dysfunction–associated steatohepatitis (MASH), a more severe form of MASLD, which can be more difficult to reverse. (MASH was formerly known as nonalcoholic steatohepatitis, or NASH.)

MASLD exists on a spectrum “ranging from fat with no scarring, which is 100 percent reversible, to cirrhosis, which is way at the other end of the spectrum and not reversible,” Rinella says. “Where you are on the spectrum of disease determines how much reversibility you’re able to get.”

Here are four things you can do to reverse MASLD:

1. Maintain a healthy weight

Not only do excess pounds raise your risk for MASLD — research shows that the overwhelming majority of people with the condition are overweight or have obesity — but losing weight and maintaining the loss is a must in terms of reversing the condition.

The good news is that you don’t have to reach your ideal weight to reap the rewards.

“If you lose 5 percent of your body weight, you can have improvement,” Rinella says. “If you lose 7 percent, you can eliminate some of the damage to the liver cells, and if you lose 10 percent, you can see improvement in scar tissue.”

Keep in mind that how you lose the weight makes a difference. According to the American Liver Foundation, rapid weight loss and poor eating habits may also lead to MASLD. Rinella recommends that her patients try the Mediterranean diet: fresh fruits and vegetables, whole grains, nuts, beans, fish and olive oil.

She also recommends coffee.

“Coffee is associated with reduced progression of scarring in the liver in both alcohol- and nonalcohol-related liver disease,” she says, citing a 2021 study published in Frontiers in Pharmacology. “Caffeinated coffee is probably better, but there’s evidence that decaf is also beneficial, even if you add milk and sugar. I tell patients to use low-fat milk rather than cream or milk, and minimal sugar or sugar substitute, because you want to be mindful of the calories.”

2. Skip fast food

In terms of reversing MASLD, what you do and don’t consume are equally important. In a 2023 study published in Clinical Gastroenterology and Hepatology, researchers found that people with obesity and people with diabetes who get at least 20 percent of their daily calories from fast food have dramatically elevated levels of fat in their liver, compared with those who consume less fast food or none at all.

“The types of foods that we eat can lead to all of the same negative side effects on the liver that we typically think of with heavy drinkers,” Kardashian says.

3. Break a sweat

Exercise plays a role in any weight loss plan, of course, but research suggests it plays a specific role in reversing MASLD that has nothing to do with losing weight. A review of studies published in 2021 in Frontiers in Nutrition found that regular exercise improved MASLD, even in patients who didn’t lose weight. It also helped prevent early-stage MASLD from progressing to MASH.

Studies show that a combination of strength training and cardio is most effective. Aim for two to three strength-training sessions a week and 150 to 300 minutes per week of moderate to vigorous aerobic activity like brisk walking, running or swimming.

“Cardio is more effective in terms of reducing fat in the liver,” says Rinella, citing other research showing that patients with MASLD who followed a regular aerobic exercise regimen — meaning moderate-intensity cardio for at least 30 minutes five days a week, or vigorous cardio for at least 20 minutes three days a week — experienced a reduction in liver fat of 10 to 43 percent.

4. Avoid alcohol

You can pretty much dismiss all those guidelines about moderate drinking if you have a fatty liver.

Research suggests there is no such thing as an OK amount of alcohol for people trying to reverse MASLD — not even the standard one drink per day for women or two drinks per day for men. A 2020 study published in Gastroenterology found that alcohol significantly affects disease progression in other forms of liver disease, including MASH.

“We’re starting to move toward the recommendation that there is no safe amount of alcohol,” says Rinella, a coauthor of the study.

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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.

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