If your diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) came as a surprise, you're not alone. Usually, you're diagnosed after a routine blood test shows higher than normal liver enzymes.
Doctors used to call MASLD nonalcoholic fatty liver disease (NAFLD) because too much fat builds up in your liver for other reasons, but not from alcohol. MASLD can happen after your metabolism gets out of balance and you’re at higher risk for other metabolic disorders.
An out of balance metabolism means your body can’t use or store energy such as fat and sugar normally. In fact, MASLD means your liver has 5% or more fat cells and you may have a metabolic problem such as:
- Obesity
- Type 2 diabetes
- High blood pressure
- High cholesterol
You may wonder exactly how MASLD affects your liver, what it means for your health, or how it’s treated. Fortunately, MASLD can be reversed using diet, exercise, and a treatment plan. Find out more about testing for MASLD and how to make doctor-approved, lasting lifestyle changes to improve your fatty liver.
First Steps After a MASLD Diagnosis
If you’ve just learned you have MASLD, a good first step is to collect information. Be an active member of your own health care team and learn as much as you can. If you feel unclear about your condition, treatment, or outlook, ask questions until you get clarity.
Questions to ask your doctor
You can ask your doctor or health care team these questions:
- How did you diagnose me with MASLD?
- Can you tell me what my testing means?
- How serious is my condition?
- Do I have any signs of inflammation or scar tissue (fibrosis)?
- What other conditions (diabetes, high cholesterol, high blood pressure) should I manage with my MASLD?
- How often should I have checkups or lab tests done?
- Should I see a specialist, such as a hepatologist or endocrinologist?
- Where can I get more information about MASLD?
What Tests Monitor MASLD?
You may have had lots of blood tests and maybe your doctor ordered imaging scans, too. The next step is to estimate (guess) your risk for liver scarring, or fibrosis.
Liver function test (LFT), complete blood count (CBC), and more
Your doctor can measure proteins, enzymes, and other substances to check the health of your liver. They can combine the amounts of proteins and substances made by your liver to estimate its stiffness, scarring, and damage.
Here are some key substances your doctor checks:
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
- Alkaline phosphatase
- Platelets (tiny cell-like bits that clot your blood)
Although some people with MASLD have normal AST and ALT, many have up to five times higher than normal amounts. Your alkaline phosphatase may also be two to three times higher than normal. But often, your platelets are lower than normal.
As you make lifestyle changes and follow your treatment plan, look for lower ALT and AST levels and higher platelet counts. This can mean improved liver health and you’re on the right track.
FIB-4 scores for liver fibrosis risk
Your doctor can use a fibrosis-4 (FIB-4) score to estimate your risk for liver scarring. A lower FIB-4 score means you have a low risk for liver fibrosis:
- Low risk, below 1.3
- Medium risk, between 1.3 and 2.67
- High risk, above 2.67
Imaging scans
Your doctor may also order vibration-controlled transient elastography (VCTE), also called liver stiffness scans. Vibration sound waves move your liver, but stiff or scarred areas don’t move normally.
“In our office, we use liver stiffness scans. A stiffened liver suggests fatty inflammation or large amounts of scar tissue,” says Alisa Likhitsup, MD, MPH, a gastroenterologist and transplant hepatologist in the division of gastroenterology and hepatology at University of Michigan in Ann Arbor.
A common tool called FibroScan (which gives results in kilopascals, or kPa) can be used along with a blood test called the enhanced liver fibrosis (ELF) score. These tests can estimate your risk for liver fibrosis:
- Medium, between 8-12 kPa; ELF between 7.7-9.8
- High, above 12 kPa; ELF above 9.8
Your doctor may add your VCTE testing with the FIB-4 score. Lower scores can mean your liver health is getting better.
Liver biopsy
If your blood and imaging scans aren’t clear, your doctor may suggest a liver biopsy. They’ll take a small liver sample to check for fat buildup, scarring, and inflammation.
MASLD Lifestyle Changes
The backbone of MASLD treatment teaches you to change your health habits. That means you’re in control of your liver health.
Unlike some conditions where medicine is the main option, with MASLD, lifestyle can be a powerful tool to:
- Slow down liver fat buildup
- Stop or slow liver inflammation
- Reverse disease progression
Research confirms that lifestyle changes alone can greatly lower the fat in your liver, especially when you start early.
MASLD habit changes
Your doctor may share some lifestyle choices to help keep your liver healthy. They may suggest that you:
- Keep immunizations up to date.
- Treat other metabolic conditions.
- Drink two cups of coffee each day.
- Get your vitamin D.
- Skip alcohol.
It’s best to cut alcohol out completely, Likhitsup says. “Avoid alcohol — it burns out the liver faster and speeds up liver damage into cirrhosis,” she says.
Weight management
Losing body weight can greatly improve liver health, Likhitsup says. Take a closer look at your diet and the amount of physical activity you get. You may need to lose more than just a couple of pounds.
“Losing 10% of your body weight can remove fat from your liver, cool down fatty inflammation, and delay the damages that cause scar tissue or cirrhosis,” Likhitsup says.
You and your doctor can put a weight loss plan together. Start small, aiming to lose 1-2 pounds each week. If you lose weight, your doctor may also check if your alanine aminotransferase (ALT) has gone down, too.
If the plan isn’t working after six months, your doctor may talk about other options. “There are several prescriptions approved for obesity, and some people may also benefit from weight loss surgery,” Likhitsup says.
Focused diet changes
A diet overhaul may feel overwhelming at first. Try to take small steps. Make a note of what you’re eating now, and look for patterns.
Then try one thing at a time, such as:
- Cut down on added sugars.
- Lower the amount of red meat and animal fats you eat.
- Choose whole foods and grains over processed options.
- Eat more vegetables, fruits, and lean proteins.
A registered dietitian can help you create new menus and give you new ideas about what to eat.
Get active again
You can enjoy activities you love, such as:
- Brisk walking
- Swimming
- Cycling
Even simple habits such as walking 15-20 minutes after meals can help. Just moving can boost your metabolism and burn calories.
“Some people start losing weight by changing diet alone if they were taking in a lot of sugar, butter, animal fat, or red meat; but the weight will stall after some time,” Likhitsup says. “So, you need to move more.”
Likhitsup says this can be as simple as:
- Setting a goal of at least 7,000 steps a day.
- Going on a walk for 15-20 minutes after every meal.
- Just getting 150 minutes of moderate, intentional movement each week.
Get enough sleep
Lack of sleep can lead to fatty liver getting worse, which is called MASLD progression. Studies show if you sleep only for five hours or less each night, you’re more likely to get MASLD in the first place.
Here are some tips to get better sleep:
Track your sleep. Log your nightly sleep time using a smart watch or other at-home device.
Review. Look over how much sleep you’re getting.
Make a note. Jot down how rested you feel each morning.
If you’re having sleep problems such as sleep apnea, talk to your doctor about doing a sleep study to find solutions to get more rest.
Other MASLD Treatments
You and your doctor will come up with a MASLD treatment plan to lower your risk of cirrhosis and repair as much liver damage as possible.
MASLD treatment options
Currently, weight loss is the main treatment for MASLD, but your doctor may suggest a medicine approved for metabolic dysfunction-associated steatohepatitis (MASH). In fact, about 25% of people with MASLD have MASH — a more serious form of MASLD.
If you have obesity and liver fibrosis stage 2 (II) or 3 (III), you may be prescribed:
Semiglutide (Wegovy)
If semiglutide doesn’t work for you, your doctor may also suggest liraglutide (Saxenda) or tirzepatide (Zepbound), which are also GLP-1 medications.
GLP-1 medications don’t work for everyone, and the liver enzymes may stay higher. If this happens, your doctor may you give you:
- Resmetirom (Rezdiffra)
Bariatric surgery
If other medicines don’t work for you, your doctor may suggest bariatric surgery. This surgery can help you lose weight and reverse your fatty liver to prevent liver damage (cirrhosis).
Tracking Your Liver Health
As you take on healthy habits, your doctor will track your progress using a mix of:
- Lab tests
- Imaging scan scores
- Lifestyle improvement goals
Your doctor will keep watching your risk for liver scarring. They'll also check to see if your risk for fibrosis is higher than before using a FIB-4 score, and may ask you to get:
- LFTs to check ALT and AST every three to four months
- Imaging scans every three years if you have MASH, weight loss isn't working, and your liver enzymes remain high
- Imaging scans every four years if you have MASH, normal liver enzymes, and reach your weight goal
If you have a lower chance for liver fibrosis or stiffness, your doctor may suggest monitoring you. You and your doctor will talk about how often you'll need follow-up visits.
Seeing a specialist
Primary care doctors may diagnose MASLD, but you may see a specialist if your:
- Liver enzymes stay high or get worse
- Testing predicts serious liver stiffness, inflammation, or scarring
- Symptoms worsen, such as ascites, enlarged spleen, or jaundice
- Primary care doctor isn’t sure about managing MASLD
“Simple labs such as a CBC and liver enzyme levels can screen for patients who should be seen by a gastroenterologist or liver specialist,” Likhitsup says. “Because most patients with fatty liver disease or MASLD die from heart disease, it is very important to have regular checkups and take good care of your metabolic health.”
To get the best care, your doctor may suggest seeing:
- A hepatologist, a liver specialist
- A gastroenterologist, a digestive system specialist
- An endocrinologist (to help you manage your diabetes and weight)
- A cardiologist, a heart specialist
Tracking your own progress
You may feel empowered when you keep up with your own health, especially when you see progress. Here are a few ways to track and note your health wins:
Keep a health journal. Track what you eat, how often you exercise, and any symptoms you have.
Use digital tools. Use apps to help you hit activity goals, track your blood sugar, and monitor your weight.
Research and keep learning. Engage in your care, and read what you can about fatty liver and other conditions.
When to call your doctor
Some symptoms can signal that your MASLD is changing to MASH. And MASH can riase your risk for cirrhosis and liver cancer. See your health care provider if you are:
- More tired than usual
- Having pain in your upper right belly (abdomen)
Empower Yourself
If you feel upset or dismissed after your MASLD diagnosis, speak up. It’s true that sometimes mild MASLD doesn’t need treatment, and your doctor may just monitor you. But you deserve support and a clear plan.
If you feel brushed off, try to:
- Ask specifically about monitoring: “How often should I get labs or imaging?”
- Request a referral, if needed.
- Get a second opinion from a different doctor.
- Be clear on the treatment steps, even if you’re not having symptoms.
“Fatty liver can turn into cirrhosis without any symptoms,” Likhitsup says. “When you have liver symptoms, it might be too far gone.”
But scientists are studying new MASLD treatments in clinical trials to lower liver fat, such as:
- Bempedoic acid (Nexletol)
- PPAR inhibitors: Pioglitazone (Actos) and saroglitazar
- SGLT2 inhibitors: Canagliflozin (Invokana) and empagliflozin (Jardiance)
MASLD is a wake-up call, but you have real power to shape your future. New liver treatments being developed may improve fatty liver care and other metabolic disorders.
Lifestyle changes and regular checkups can help you reverse and prevent liver damage. Talk to your doctor about the best plan to treat your fatty liver.
