Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD), now called metabolic dysfunction-associated steatotic liver disease (MASLD), is the buildup of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis). The more advanced form of NAFLD is nonalcoholic steatohepatitis (NASH), now called metabolic dysfunction-associated steatohepatitis (MASH). NASH causes the liver to swell and become damaged.

We encourage adults living with MASH/NASH to visit our MASH Featured Clinical Trial page to learn more about potential opportunities in their area. Visit the page today.

Facts at-a-Glance

1. About 100 million people (about 25%) in the United States are estimated to have Nonalcoholic fatty liver disease (now called MASLD).
2. NAFLD is the most ordinary form of liver disease in children and has more than doubled over the past 20 years.

Information for the Newly Diagnosed

What are the risks for developing Nonalcoholic Fatty Liver Disease (NAFLD)?

Nonalcoholic fatty liver disease (now known as MASLD) tends to develop in people who are overweight or obese or have diabetes, high cholesterol, or high triglycerides. These conditions combined are known as metabolic syndrome. Rapid weight loss and poor eating habits also may lead to NAFLD. Certain medications may increase one’s chances of developing NAFLD. It is important to note, however, that some people develop fatty liver even if they do not have the most common risk

What is the NAFLD/heart health connection?

Nonalcoholic Fatty Liver Disease, or NAFLD (now known as MASLD, or Metabolic Associated Steatotic Liver Disease) and cardiac (heart) disease have similar causes, including metabolic syndrome.  Metabolic syndrome is a grouping of health conditions that include high triglycerides, high blood sugar levels, prediabetes and Type 2 diabetes, and high blood pressure. Other factors include obesity and excess fat around the abdomen (belly area).

Current medical recommendations suggest the importance of discussing the NAFLD/heart disease connection with a health care provider if you have NAFLD. Although you may be worried about your liver health, death from cardiovascular disease (CVD) is more common than liver complications among people with fatty liver. Even if the fatty liver disease would progress to significant fibrosis (scarring in the liver that is cirrhosis or nearly cirrhosis), the risk of CVD remains higher.

What happens if NAFLD gets worse?

Nonalcoholic fatty liver disease (now called MASLD) can get worse and cause liver inflammation (enlargement or swelling) and damage called nonalcoholic steatohepatitis (NASH, which has been renamed MASH). Cirrhosis (scar buildup) can develop if NASH advances.  Early diagnosis of NAFLD, along with following medical advice, can reduce a person’s chance NAFLD progressing to NASH and cirrhosis.

What are the symptoms of NAFLD?

Nonalcoholic fatty liver disease (now called MASLD) often has no symptoms, but if they occur, If symptoms begin, they usually include fatigue (extreme tiredness), weakness, discomfort or pain in the abdomen.

If NALFD begins to advance to NASH (now known as MASH), other symptoms may begin. These can include jaundice (yellowing of the eyes and skin), severe itching, fluid buildup in the belly (ascites) and fluid buildup in the ankles (edema). Sometimes mental confusion can occur.

How is NAFLD diagnosed?

Nonalcoholic fatty liver disease (now called MASLD) may be suspected if blood tests show higher than normal levels of liver enzymes. Usually, doctors will have to rule out other probable causes of higher-than-normal liver enzymes before they know for sure if someone has NAFLD. They will review a person’s medical history and will often order additional tests such as ultrasound, which can show what the liver looks like, to see if anything looks abnormal.

How is NAFLD treated?

There are no medications approved yet for nonalcoholic fatty liver disease (now called MASLD). Eating a healthy diet and adding physical movement to your day may help prevent liver damage from starting or reverse it in the initial stages. Here are suggestions for people who have NAFLD:

• See a liver specialist (gastroenterologist or hepatologist) to monitor and advise you about your liver health.
• If you are overweight or obese, speak to your doctor or a dietitian to learn more about planning healthy meals that can help you lose weight.
• If you have high cholesterol or high triglycerides, speak with your doctor about how to lower your numbers to a healthier range.
• If you have diabetes, speak with your doctor about managing your condition.
• Avoid alcohol (beer, wine, hard liquor) to lower the risk of additional liver damage.

 Can NAFLD be prevented?

There are things people can do to lower their chances of developing NAFLD (now called MASLD). They include:

• Maintain a healthy weight.
• Eat meals that contain lean proteins, whole grains, fruits, vegetables, healthy oils, and low-fat dairy products.
• Try to include some kind of physical movement during most days of the week. If you are not currently physically active, speak with your doctor about the types of activities you can do that are safe for your current physical abilities.
• Limit or avoid alcohol intake.
• Only take medicines that you need and follow dosing recommendations.

NAFLD and Pregnancy

While NAFLD (now called MASLD) can affect people of all ages, sexes, and ethnicities, it is important to consider its specific implications during pregnancy and in those intending to become pregnant. NAFLD affects about 18% of pregnant women, and pregnancy can exacerbate existing NAFLD due to normal hormonal changes, largely by increased estrogen, and the natural insulin resistance of pregnancy.

The risk factors for developing NAFLD during pregnancy are similar to times outside of pregnancy, and include obesity, pre-existing diabetes, prior gestational diabetes, and advanced maternal age. Being diagnosed with NAFLD prior to pregnancy is associated with an increased risk of developing gestational diabetes, hypertensive complications such as pre-eclampsia, preterm birth, adverse fetal outcomes, and childhood development of obesity and NAFLD in the offspring. Diagnosis typically involves ultrasonography after investigation for other causes of elevated liver enzymes.

Once NAFLD is determined, management of the condition focuses on lifestyle interventions (health dietary modifications and appropriate physical activities permitted during pregnancy) as there are no approved medications for NAFLD in pregnancy. Prior to pregnancy, preconception counseling, weight management, and optimal blood sugar control are important measures for preventing the development or progression of NAFLD. Importantly, breastfeeding may reduce NAFLD risk for both the mother and their child. Ultimately, close monitoring during pregnancy is crucial to reduce risks and improve outcomes for both the mother and her child. Download a fact sheet about NAFLD (MASLD) and pregnancy. 

Questions to Ask Your Doctor

• What condition do I have that suggests NAFLD (now referred to as MASLD)?
• Can NAFLD (MASLD) be reversed? How long can this process take?
• Do I have cirrhosis or scarring of the liver?
• If I have cirrhosis, how advanced is it?
• What kinds of dietary and lifestyle changes do you suggest that I make?
• Can you refer me to a registered dietitian or nutritionist to help me plan healthy meals?
• What kinds of physical activities would be OK for me to do?
• Is there a treatment or medication for NAFLD? Are there any clinical trials that might be good for me?
• Will losing weight reverse this disease and help my liver go back to full health?

Support Group

NASH (now called MASH) Support Group on Facebook
Visit the American Liver Foundation Nonalcoholic Steatohepatitis (NASH), now called metabolic dysfunction associated steatohepatitis or MASH, support group on Facebook. For more details, click here…

Clinical Trials

We encourage adults living with NAFLD to visit our Clinical Trials page to learn more about opportunities in their area. Visit our Clinical Trials page today.

New Nomenclature (Name) of NAFLD

NAFLD has been newly renamed metabolic dysfunction-associated steatotic liver disease or MASLD. Learn about the new nomenclature (terminology) changes to NAFLD here.

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Search for a Clinical Trial

Clinical trials are research studies that test how well new medical approaches work in people. Before an experimental treatment can be tested on human subjects in a clinical trial, it must have shown benefit in laboratory testing or animal research studies. The most promising treatments are then moved into clinical trials, with the goal of identifying new ways to safely and effectively prevent, screen for, diagnose, or treat a disease.

Speak with your doctor about the ongoing progress and results of these trials to get the most up-to-date information on new treatments. Participating in a clinical trial is a great way to contribute to curing, preventing and treating liver disease and its complications.

Start your search here to find clinical trials that need people like you.

Last updated on February 13th, 2025 at 10:08 am