Millions of Americans are affected by a common yet frequently overlooked liver disease that often progresses without noticeable symptoms, according to health experts. Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is estimated to impact up to one in three U.S. adults, or approximately 80 million people.
The condition develops when excess fat accumulates in the liver, a process increasingly linked to rising rates of obesity and type 2 diabetes. Sedentary lifestyles and diets high in processed foods, sodium, saturated fat, and added sugar are also contributing factors, experts note, leading to the disease appearing in younger populations. Cases in children have reportedly doubled over the past two decades.
Many individuals remain undiagnosed because MASLD often causes no obvious symptoms, or its signs are easily mistaken for less serious health issues. Recruiter Hannah Fewtrell, 49, initially attributed her constant exhaustion and dark circles under her eyes to menopause, despite maintaining a healthy lifestyle that included daily walks and a balanced diet. A scan in October revealed the true cause: stage 3 fatty liver disease.
"I was in shock," Fewtrell said. "I'm not that old, and I thought I was taking good care of myself."
While not everyone with excess fat in their liver develops severe complications, the buildup can impair liver function and cause inflammation. Over time, this can lead to scarring, cirrhosis, and potentially liver failure. However, early detection and intervention can halt or even reverse the damage.
Studies indicate that weight loss is a key factor in managing MASLD. Experts suggest losing at least 5% of body weight can reduce liver fat and inflammation. The Mediterranean diet, emphasizing fruits, vegetables, whole grains, lean proteins, and healthy fats like olive oil, has also been shown to reduce liver fat, even without significant weight loss. Minimally processed foods are recommended, while fast food and sugary snacks should be avoided. Some specialists also advise reducing or eliminating alcohol consumption, as even moderate drinking may exacerbate the condition.
Exercise, particularly a combination of aerobic activities and strength training, is also crucial. Experts recommend 150 to 300 minutes of exercise per week, spread across three to five days, including aerobic workouts and two strength-training sessions. Simple exercises like squats or lifting household items can contribute to muscle strength, which may improve the body's ability to burn fat.
Fewtrell implemented significant lifestyle changes, including a dietitian-guided plan that resulted in a 14-pound weight loss. Subsequent scans showed a dramatic improvement in her liver condition. "I feel so much better," she stated. "I have so much more energy. I'm sleeping better and I'm much less bloated."
Emerging drug treatments are also showing promise. Medications like semaglutide (found in Wegovy and Ozempic) and resmetirom (Rezdiffra) are being studied for their effects on reducing liver fat, inflammation, and scarring. However, experts caution that lifestyle changes remain the cornerstone of treatment and prevention.
While various supplements are marketed for liver health, including milk thistle and vitamin E, specialists emphasize that strong clinical evidence supporting their efficacy in treating MASLD is lacking. Some herbal supplements may even pose risks or interact with prescription medications. Consulting a primary care doctor for assessment and guidance is recommended for individuals concerned about their liver health.