Written by: Roslyn Marano
Medical review and contribution by: Jonathan G. Stine, MD
Making the lifestyle changes needed to manage MASLD can be a challenge, but the choices you make today can lead to a healthier tomorrow.
A Bionews and Liver Disease News Special Feature
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80-100
million
people affected
2nd most common
reason for liver transplant
Early
action
is key
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in the U.S., affecting 80-100 million people. Driven by metabolic conditions like obesity, type 2 diabetes, high blood pressure, and high cholesterol, its rising prevalence is a growing public health concern.
More than 2 in 5 adults experience obesity, with rates of 41% among women and 39% among men, making it one of the biggest drivers of MASLD. This condition is often a “silent disease,” meaning symptoms may not appear until significant liver damage has occurred.

In some cases, MASLD progresses to metabolic dysfunction-associated steatohepatitis (MASH), a more severe form that includes liver inflammation and scarring. If left untreated, MASH can lead to fibrosis (scarring), cirrhosis, liver failure, or even liver cancer.

Today, MASLD and MASH are the second most common reasons for liver transplants in the U.S., with related liver cancer being the fastest-growing cause. MASLD is expected to become the leading reason for transplants, highlighting the need for early intervention. Globally, MASLD rates have surpassed 40% in the Americas and Southeast Asia, and cases are projected to rise significantly — affecting 1 in 2 adults — by 2030.

The good news: Progression is not inevitable. Lifestyle changes, such as a balanced diet, regular exercise, and managing diabetes or obesity, can slow or even reverse early-stage MASLD. Cutting processed foods, maintaining a healthy weight, and staying active can improve liver function and reduce complications.

Because MASLD often has no symptoms, early action is key. Understanding risk factors and making informed choices regarding lifestyle can have a lasting impact on liver health. Small but consistent steps can help prevent severe disease and support overall well-being.
MASLD
Explained
Meet the Patients
Stephen W. Smith
As an Army lawyer, Stephen Smith spent decades serving others, but a MASLD diagnosis was a reminder that he needed to focus on his own health.
Walton Harrold
In 2015, IT specialist Walt Harrold faced a wake-up call with his MASLD diagnosis. For the past 10 years, he has been actively managing his health.
MASLD Basics Explained
Watch: Dr. Stine explains the basics of MASLD and how it progresses.
Meet the
Expert
Headshot of expert
Our Expert
Jonathan G. Stine, MD
Gastroenterology, Transplant Hepatology Research Director, Penn State Health Liver Center
An internationally recognized liver expert, Jonathan Stine, MD, is an associate professor at Penn State. He has authored over 115 peer-reviewed papers on MASLD and exercise and leads Penn State’s Fatty Liver Program. An NIH-funded researcher, he was chair of the International Roundtable on MASLD and Physical Activity and serves on hepatology journal editorial boards.
Risk Factors for Progression
  • Obesity
  • Type 2 diabetes
  • High blood pressure
  • High triglycerides and low HDL cholesterol
  • Genetics
  • Other
  • Watch video
Risk factor 1
Obesity
Obesity, or having too much body fat, especially around the belly, is one of the biggest risk factors for MASLD. More than 75% of people with MASLD are obese, and in cases of severe obesity, nearly 90% are affected. 

Extra fat in the body, especially around the liver or other organs, leads to inflammation and insulin resistance. This causes liver damage to worsen over time. Fat cells also release hormones and chemicals that promote scarring in the liver. 

Obesity increases the risk of progressing from fatty liver to advanced liver scarring and cirrhosis. Managing weight through healthy eating and physical activity is one of the best ways to protect the liver and slow disease progression.
Risk factor 2
Type 2 diabetes
People with diabetes have a much higher risk of developing liver disease. Up to 70% of people with MASLD have insulin resistance, meaning their bodies can’t use insulin properly. This leads to high blood sugar and fat buildup in the liver, which can cause scarring.

MASLD is also a pre-diabetic condition, increasing the risk of type 2 diabetes (when the body struggles to regulate blood sugar) by 2 to 5 times, especially with severe liver damage. Because of this, people with type 2 diabetes should be screened for MASLD, regardkess of whether they are experiencing symptoms. Managing blood sugar can help protect the liver.
Risk factor 3
High blood pressure
High blood pressure doesn’t just strain the heart — it also takes a toll on the liver. Elevated blood pressure increases stress on the liver’s small blood vessels, contributing to fibrosis.

Research indicates that MASLD affects approximately 50% of individuals with high blood pressure. Because hypertension often coexists with obesity and diabetes, managing it through medication, a balanced diet, and regular exercise can help protect liver health and reduce long-term damage.
Risk factor 4
High triglycerides and low HDL cholesterol
High triglycerides and low high-density lipoprotein (HDL) cholesterol, also known as dyslipidemia, are key risk factors for MASLD. Triglycerides (a type of fat in the blood) and HDL (the "good" cholesterol that helps remove fats) are often imbalanced in MASLD patients.

Research shows that elevated lipid levels are common in MASLD. Managing cholesterol through a healthy diet, regular exercise, and medication can help slow liver disease progression and support overall metabolic health.
Risk factor 5
Genetics
Genetics contribute to MASLD risk by influencing how the liver stores and processes fat. Some people inherit genetic variations that increase their risk of developing MASLD, even if they do not have obesity or diabetes. The PNPLA3 gene variant (I148M) is one of the strongest genetic risk factors, leading to increased liver fat accumulation and a higher likelihood of fibrosis and cirrhosis.

Certain racial and ethnic groups, such as Hispanic populations, have a higher genetic predisposition to MASLD, contributing to its increased prevalence and severity. While genetic predisposition alone does not cause MASLD, it can intensify the effects of metabolic risk factors, making disease progression more likely.
Risk factor 6
Other
MASLD often coexists with conditions that contribute to its progression:

  • Polycystic ovary syndrome causes insulin resistance and hormonal imbalances, increasing liver fat.
  • Obstructive sleep apnea lowers oxygen and triggers inflammation, worsening liver damage.
  • Hypothyroidism slows metabolism, promoting liver fat buildup.
  • Growth hormone deficiency increases visceral fat, leading to liver steatosis.
These conditions share pathways of insulin resistance, hormonal imbalances, and inflammation, driving MASLD progression.
Dr. Stine talks about why regular liver checkups are important for people with any of the MASLD risk factors.
MASLD
Stages of
Progression
  • steatosis
  • steatohepatitis
  • fibrosis
  • cirrhosis
MASLD progresses through distinct stages, from early fat accumulation to severe scarring that impairs function. While early stages can often be reversed with lifestyle changes, advanced stages require careful management to prevent serious complications. Understanding these stages — steatosis, steatohepatitis, fibrosis, and cirrhosis — can help guide early intervention and improve long-term liver health.
Dr. Stine discusses MASLD stages and how emerging therapies can reverse cirrhosis.
Steatosis
Steatosis is the earliest and most reversible stage of MASLD. 
The liver can heal itself with early intervention through lifestyle changes like healthy eating, regular exercise, weight loss, stress management, and avoiding alcohol and smoking. Losing just 5% of body weight can significantly reduce liver fat and begin to reverse the disease.

MASLD often has no symptoms and is typically discovered through routine medical tests. A quarter of U.S. adults have MASLD, and about 20% progress to the more severe stage, MASH.

Addressing metabolic factors like obesity is key to preventing progression and ensuring better liver health.
Steatohepatitis
Steatohepatitis, the stage that distinguishes MASH, involves liver inflammation alongside fat accumulation.
While reversal is possible, it requires significant lifestyle changes, including a healthy diet, regular exercise, and managing conditions like obesity and diabetes. Losing 10% or more of body weight can resolve inflammation and reverse early scarring.

Symptoms may include abdominal pain, fatigue, or loss of appetite, though many experience no noticeable signs. Early intervention can reduce inflammation and allow some healing.

If left untreated, MASH can progress to fibrosis (scarring), where reversal becomes much more difficult, emphasizing the importance of timely action to prevent further liver damage.
Fibrosis
Fibrosis occurs when prolonged liver damage causes scar tissue to form, disrupting liver function. 
It progresses through four stages, with early stages being partially reversible through lifestyle changes and addressing underlying causes. As fibrosis advances, scar tissue becomes permanent, making reversal difficult.

Symptoms like fatigue, abdominal pain, or appetite changes often stem from underlying conditions like MASH, not fibrosis itself. Treatment aims to prevent further damage and progression to cirrhosis, where liver function is severely impaired.

Early diagnosis and intervention are critical for improving outcomes, highlighting the importance of managing fibrosis proactively to maintain liver health.
Cirrhosis
Cirrhosis, the final stage of liver disease, occurs when extensive scarring impairs the liver's function. 
Possible symptoms may include jaundice, nausea, severe itching, ascites (abdominal swelling), easy bruising, spider-like blood vessels, loss of appetite, confusion, bleeding from the intestines, and swelling in the legs or ankles. While the liver may still perform critical functions initially, damage is often too extensive for reversal once symptoms appear.

Treatment focuses on managing these symptoms, preventing complications, and slowing progression. If cirrhosis advances to liver failure, a transplant may be necessary.

Detecting and addressing issues early is crucial to preventing cirrhosis and its severe health complications.
?
QUIZ
Myth or fact?
Your liver plays a crucial role in keeping your body healthy, but there are many misconceptions about liver disease, particularly MASLD and MASH. Do you know the facts from the myths? Take this quick quiz to test your knowledge and learn how lifestyle choices can affect liver health.
MYTH
“Only heavy drinkers get liver disease.”
MYTH
FACT
While heavy alcohol consumption can lead to liver disease, MASLD, by definition, develops in individuals who drink little to no alcohol. Factors such as being overweight, having a family history of the condition, or having specific metabolic conditions can contribute to MASLD.
NEXT
FACT
“Not everyone with MASLD is overweight.”
MYTH
FACT
Although being overweight or obese increases the risk of developing MASLD, the condition can also occur in individuals who are at a healthy weight. Genetics, type 2 diabetes, high cholesterol levels, and poor nutrition are among other factors that can lead to fat accumulation in the liver.
NEXT
FACT
“MASLD and MASH often have no symptoms until advanced stages.”
MYTH
FACT
In the early stages, MASLD and MASH may present no noticeable symptoms. When symptoms do occur, they are often subtle, like abdominal pain, loss of appetite, and fatigue, which are common to other health issues as well. As the disease progresses, nausea, dark urine, or jaundice may develop. Seek medical attention if these occur.
NEXT
MYTH
“MASH and MASLD can’t be cured.”
MYTH
FACT
While no specific medication can cure MASLD, lifestyle changes such as weight loss, regular exercise, and a balanced diet can help manage and potentially reverse the condition.
NEXT
FACT
“Processed foods increase your risk of developing MASH and MASLD.”
MYTH
FACT
Diets high in processed foods, added sugars and unhealthy fats contribute to insulin resistance, obesity, and inflammation, all of which increase the risk of MASLD and MASH. A diet rich in whole foods, fiber, and healthy fats can support liver health and manage fatty liver disease.
NEXT
MYTH
“Health supplements can prevent liver disease.”
MYTH
FACT
No health supplement has been proven to fully prevent MASLD or other liver diseases. While some may support liver health, a balanced diet and healthy lifestyle remain the most effective prevention strategies. In some cases, health supplements can be harmful to the liver, and you should speak to a healthcare provider before starting one.
NEXT
MYTH
“People with MASLD should avoid all fats in their diet.”
MYTH
FACT
Not all fats are harmful. Healthy fats, such as those found in nuts, avocados, and olive oil, can support liver function and overall metabolic health. However, trans fats and excessive saturated fats should be limited.
NEXT
FACT
“MASLD is one of the most common liver diseases worldwide.”
MYTH
FACT
MASLD is a widespread liver condition affecting 30% of the global population. Its prevalence is rising due to factors such as obesity, type 2 diabetes, metabolic syndrome, and sedentary lifestyles. In the U.S., 38% of children with obesity have MASLD, highlighting the need for early detection and preventive measures across all age groups.
NEXT
Hear More From Our Patients
Stephen and Walton give some advice for others who have been diagnosed with MASLD, as well as the impact the diagnosis has had on their families.
Stephen shares his advice on how regular check-ups can make a difference.
Stephen talks about his biggest regret and what he wishes he would have done differently for his health.
Walt shares how living with MASLD affects not only him but his family as well.
Walt talks about how he can’t change the past but he can change his future through healthy choices.
?
Quiz:
This or that?

Your daily choices matter when it comes to your liver health. Some options may seem healthy, but could actually increase liver fat and inflammation. Take our “this or that” quiz to see if you’re making the best choices — and find out why it matters.

START >

Quiz: This or that?
Fresh Smoothie
VS
Store-bought Smoothie
Best Choice: Fresh smoothie

A homemade smoothie allows for natural ingredients without added sugars or syrups that can contribute to liver fat accumulation. Many store-bought options contain high amounts of added sugar, which can worsen insulin resistance.

Quiz: This or that?
Nuts
VS
Granola Bar
Best Choice: Nuts

Nuts contain healthy fats and proteins that help you feel full and reduce liver inflammation. Many granola bars, even those marketed as healthy, contain added sugars and processed oils that may contribute to liver fat accumulation.

Quiz: This or that?
Grilled Salmon
VS
Rotisserie Chicken
Best Choice: Grilled Salmon

Salmon is rich in omega-3 fatty acids, which help reduce liver fat and inflammation. While rotisserie chicken can be a good option, it is often seasoned with high-sodium marinades that may not be as liver-friendly, and the skin is high in saturated fat.

Quiz: This or that?
Black Coffee
VS
Flavored Latte
Best Choice: Black Coffee

Black coffee contains antioxidants and polyphenols that may help protect the liver and reduce fat buildup. Flavored lattes, especially those with syrups and whipped cream, are high in sugar and unhealthy fats that can contribute to liver disease.

Quiz: This or that?
Aerobic Exercises
VS
Strength Training
Best Choice: Both

Aerobic exercise improves cardiovascular fitness, enhances lung capacity, and helps manage weight. It also reduces liver fat and inflammation, supporting liver function. Examples include brisk walking, swimming, cycling, and low-impact aerobics. Strength training builds muscle and counteracts MASLD symptoms, using resistance bands, free weights, or machines, with rest between sessions. Both together are more effective than either in isolation.

This or
That?

Thank You
MASLD progression can be managed. By identifying warning signs and liver disease risks, you can take tangible steps to safeguard your liver health. Small yet steady changes in lifestyle — like proper nutrition, regular exercise, and controlling metabolic conditions — can help slow down or even reverse early damage.

Being aware and taking action is key to making the right choices for your long-term liver health. Whether through early screenings, healthier habits, or medical guidance, preventive measures are one of the best defenses against serious complications later on. Take a step toward better health by caring for your liver.
Dr. Stine sums up the importance of getting proactive about your liver health and taking small steps today to lead the life you want to live.
Before you go, take our pledge to prioritize liver health and share your insights in our short survey below.
30-Day Liver Challenge
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Additional Resources

Discover our Healthy Liver Living guide on Liver Disease News for resources on managing MASLD and MASH.

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