Fatty Liver Disease: The Complete Guide to MASLD, Causes and Reversing It

Fatty liver disease is now the most common liver condition in the world. It affects an estimated 30 percent or more of adults globally, with even higher rates among people living with obesity and type 2 diabetes. Most people have no idea they have it, because it rarely causes symptoms until the liver is seriously damaged. For a significant minority, it progresses silently to inflammation, scarring, cirrhosis, liver failure and liver cancer. It is also strongly linked to heart disease, which is the most common cause of death in people with fatty liver.

The most hopeful fact about fatty liver disease is that it is often reversible. The liver has a remarkable ability to heal, and losing a modest amount of weight can reduce liver fat, calm inflammation and even reverse early scarring. This complete guide explains the new names for fatty liver disease, why it happens, who is at risk, which tests matter, how to reverse it through diet and activity, the role of alcohol, the new medicines now available, and how to protect your heart and overall health.

What is fatty liver disease?

A healthy liver contains a small amount of fat. Fatty liver disease, known medically as steatotic liver disease, is diagnosed when fat makes up more than about five percent of the liver. Excess fat in liver cells can cause stress, inflammation and, over time, scarring (fibrosis).

The new names: MASLD and MASH

In 2023, international liver organisations agreed new names to describe fatty liver more accurately and without stigmatising language:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) replaces the older term non-alcoholic fatty liver disease (NAFLD). It describes fatty liver in someone with at least one cardiometabolic risk factor, such as overweight, high blood sugar or diabetes, high blood pressure, high triglycerides or low HDL (“good”) cholesterol, and who drinks little or no alcohol.
• Metabolic dysfunction-associated steatohepatitis (MASH) replaces non-alcoholic steatohepatitis (NASH). It describes MASLD with inflammation and liver cell damage, which is more likely to progress to scarring.
• MetALD describes people with metabolic risk factors who also drink moderate to significant amounts of alcohol, recognising that both contribute.
• Alcohol-related liver disease (ALD) remains the term when alcohol is the main cause.

You may still see the older terms NAFLD and NASH in many articles and reports. They describe essentially the same conditions.

How fatty liver disease progresses

Fatty liver disease can be thought of as a spectrum:

1. Simple steatosis: fat in the liver without significant inflammation. This is the most common stage and is usually reversible.
2. Steatohepatitis (MASH): fat plus inflammation and liver cell injury.
3. Fibrosis: scarring builds up as the liver tries to repair itself. Fibrosis is graded from mild (F1) to advanced (F3).
4. Cirrhosis (F4): extensive scarring that distorts the liver’s structure and affects its function. Cirrhosis can lead to liver failure and increases the risk of liver cancer.

Not everyone progresses. Many people stay at the simple steatosis stage for life. The degree of fibrosis is the single most important factor predicting future liver problems, which is why tests that assess scarring matter so much. Progression usually takes many years, which gives a valuable window for action.

Who is at risk?

Fatty liver disease is closely linked to metabolic health. Major risk factors include:

• Overweight and obesity, especially fat around the waist (central obesity).
• Type 2 diabetes and prediabetes: more than half of people with type 2 diabetes have fatty liver, and they are at higher risk of advanced scarring.
• High blood pressure.
• High triglycerides and low HDL cholesterol.
• Metabolic syndrome: a cluster of the above.
• Polycystic ovary syndrome (PCOS).
• Obstructive sleep apnoea.
• Underactive thyroid and some other hormonal conditions.
• Older age.
• Genetics: certain gene variants, such as PNPLA3, increase risk and are more common in some populations, including people of Hispanic descent.
• Ethnicity: people of South Asian and East Asian descent can develop fatty liver and diabetes at lower body weights.
• Diet: high intake of sugary drinks, refined carbohydrates, processed foods and excess calories.
• Physical inactivity.

Fatty liver can also occur in people who are not overweight, sometimes called “lean MASLD”. These people often have other metabolic risk factors, genetic susceptibility or excess fat around the organs despite a normal body mass index.

Other causes of fat in the liver, which need to be considered, include certain medicines (such as long-term steroids, tamoxifen, methotrexate and amiodarone), hepatitis C, rapid weight loss, malnutrition and rare inherited conditions.

Fatty liver in children

MASLD is now the most common liver disease in children and teenagers in many countries, driven by rising childhood obesity. Children with obesity, especially those with other risk factors, may be screened with blood tests. Treatment focuses on healthy family lifestyle changes rather than dieting, and on reducing sugary drinks and increasing physical activity.

Symptoms

Most people with fatty liver disease have no symptoms. When symptoms do occur, they are often vague:

• Tiredness.
• A dull ache or discomfort in the upper right side of the abdomen.

Symptoms of advanced liver disease or cirrhosis include:

• Yellowing of the skin and whites of the eyes (jaundice).
• Swelling of the abdomen (ascites) and legs.
• Easy bruising or bleeding.
• Itching.
• Confusion, drowsiness or personality changes (hepatic encephalopathy).
• Vomiting blood or passing black stools.
• Unexplained weight loss and muscle wasting.

Seek urgent medical help for vomiting blood, black stools, confusion, or yellowing of the skin and eyes.

How fatty liver disease is diagnosed

Fatty liver is often found by chance on an ultrasound scan or when blood tests show raised liver enzymes. However, liver enzymes can be completely normal in people with fatty liver, even with significant scarring. Diagnosis involves several steps.

Finding fat in the liver

• Ultrasound scan: widely available and the most common way fatty liver is first identified.
• CT or MRI scans: can also show liver fat; MRI can measure it precisely.
• Controlled attenuation parameter (CAP): measured during a FibroScan.

Checking for other causes

Blood tests check for viral hepatitis, autoimmune liver disease, iron overload and other conditions, and alcohol intake is carefully assessed.

Assessing scarring: the most important step

Because fibrosis predicts future problems, international guidelines recommend assessing scarring in people with fatty liver, using a step-by-step approach:

• FIB-4 score: a simple calculation using age, two liver enzymes (AST and ALT) and platelet count. A low score makes advanced scarring unlikely. Intermediate or high scores lead to further testing. FIB-4 is less accurate in people under 35 and over 65.
• Elastography (FibroScan or similar): a quick, painless ultrasound-based test that measures liver stiffness. Stiffer livers have more scarring.
• Blood tests such as the Enhanced Liver Fibrosis (ELF) test: used in some countries as a second step.
• MR elastography: a specialised MRI test available in some centres.
• Liver biopsy: a small sample of liver taken with a needle. It is the most accurate way to assess inflammation and scarring, but is invasive and now reserved for selected cases.

If you have fatty liver, ask whether your FIB-4 score has been calculated or whether you need a FibroScan. Many people are told they have fatty liver without anyone assessing scarring.

Who should be checked?

Many guidelines now recommend that people with type 2 diabetes, obesity with other metabolic risk factors, or two or more metabolic risk factors be assessed for fatty liver and fibrosis, typically starting with a FIB-4 score. Recommendations vary by country.

Reversing fatty liver: weight loss

For people with overweight or obesity, weight loss is the most effective treatment for MASLD. The evidence is clear and encouraging:

• Losing 3 to 5 percent of body weight reduces liver fat.
• Losing 7 to 10 percent can reduce inflammation and resolve MASH in many people.
• Losing 10 percent or more can reverse fibrosis in a significant proportion of people.

For someone weighing 100 kilograms, a 7 to 10 percent loss means 7 to 10 kilograms. Gradual weight loss of around 0.5 to 1 kilogram a week is recommended. Very rapid weight loss through crash diets can temporarily worsen liver inflammation.

Even people with lean MASLD benefit from modest weight loss of 3 to 5 percent, along with exercise and dietary changes.

Our complete guide to weight management explains practical, sustainable approaches.

Diet for fatty liver

No single diet is right for everyone, but the following principles have the strongest evidence:

Follow a Mediterranean-style eating pattern

The Mediterranean diet is recommended by major liver societies. It is rich in vegetables, fruit, legumes, wholegrains, nuts, seeds, olive oil and fish, with limited red and processed meat, refined carbohydrates and sugar. It reduces liver fat even without significant weight loss and protects the heart. Similar eating patterns based on traditional diets around the world, rich in plants and low in processed foods, are also beneficial.

Cut sugary drinks and added sugar

Fructose, found in table sugar, high-fructose corn syrup and many sweetened drinks, is converted to fat in the liver very efficiently. Cutting out sugary soft drinks, energy drinks, sweetened teas and coffees, and limiting fruit juice is one of the most effective changes you can make.

Reduce refined carbohydrates and ultra-processed foods

White bread, white rice in large quantities, pastries, biscuits, sweets and processed snacks drive liver fat. Choose wholegrain versions, control portions and fill half your plate with vegetables.

Choose healthy fats

Replace saturated fats (found in fatty meat, butter, ghee, palm oil and many processed foods) with unsaturated fats from olive oil, nuts, seeds, avocados and oily fish.

Eat enough protein and fibre

Protein helps preserve muscle during weight loss. Fibre from vegetables, legumes and wholegrains supports blood sugar control and gut health.

Coffee

Interestingly, regular coffee consumption, around two to three cups a day without added sugar, is associated with lower risk of liver fibrosis in many studies. Coffee is not a treatment, but for people who already drink it, there is no need to stop.

Approaches that also work

Calorie reduction, intermittent fasting, lower-carbohydrate diets and other approaches can all reduce liver fat if they lead to sustained weight loss. The best diet is one you can maintain long term.

Physical activity

Exercise reduces liver fat even without weight loss, improves insulin sensitivity and protects the heart. Recommendations include:

• At least 150 minutes a week of moderate aerobic activity, such as brisk walking, cycling, swimming or dancing, or 75 minutes of vigorous activity.
• Resistance training two or more times a week, such as weights, bands or body-weight exercises, which builds muscle and improves blood sugar control.
• Reducing sitting time by breaking up long periods of sitting with short walks.

Any increase in activity helps. Start where you are and build gradually.

Alcohol and fatty liver

Alcohol and metabolic fatty liver disease work together to damage the liver. People with MASLD should limit alcohol, and those with significant fibrosis or cirrhosis should avoid it completely. There is no safe amount of alcohol for people with advanced liver scarring. If you find it difficult to reduce alcohol, ask for support; effective help is available.

Medicines for fatty liver disease

For many years there were no approved medicines specifically for fatty liver disease. This is changing:

• Resmetirom, a medicine that acts on thyroid hormone receptors in the liver, was approved in the United States in 2024 for adults with MASH and moderate to advanced fibrosis (but not cirrhosis), alongside diet and exercise. It has since been approved in some other regions.
• GLP-1 receptor agonists, such as semaglutide, used for type 2 diabetes and weight management, reduce liver fat and inflammation. Semaglutide has shown benefits for MASH with fibrosis in clinical trials and has received regulatory approval for this use in some countries.
• Pioglitazone, a diabetes medicine, improves MASH in people with and without diabetes, but can cause weight gain and fluid retention.
• SGLT2 inhibitors, another class of diabetes medicine, may reduce liver fat and protect the heart and kidneys.
• Vitamin E has been used in some people without diabetes who have biopsy-proven MASH, but long-term safety concerns limit its use.

Many more medicines are in clinical trials. Medicines are used alongside, not instead of, lifestyle changes. Do not take supplements or herbal products marketed as “liver detox” or “liver cleanse” without advice; some can actually harm the liver.

Weight-loss surgery

For people with severe obesity and fatty liver disease, bariatric (weight-loss) surgery can lead to large and sustained weight loss, resolution of MASH and improvement in fibrosis in many cases. It is considered for people who meet the criteria for surgery in their country. People with cirrhosis need specialist assessment, as surgery carries higher risks.

Protecting your heart, kidneys and metabolic health

Most people with fatty liver disease are more likely to die from cardiovascular disease than from liver disease. Fatty liver is also linked to type 2 diabetes, chronic kidney disease and some cancers. Managing your overall health is therefore essential:

• Have your blood pressure, cholesterol and blood sugar checked and treated if needed.
• Statins are safe for most people with fatty liver disease, including those with compensated cirrhosis, and they reduce heart attack and stroke risk. Do not stop or avoid statins because of a fatty liver diagnosis unless a specialist advises it.
• Stop smoking.
• Get screened for diabetes if you have not been.
• If you have sleep apnoea symptoms, ask to be assessed.

If you have cirrhosis

People with cirrhosis need regular specialist follow-up, including:

• Ultrasound scans, often with a blood test, every six months to look for liver cancer early.
• Screening for enlarged veins in the oesophagus (varices), which can bleed.
• Vaccination against hepatitis A and B, influenza and pneumococcus.
• Avoiding alcohol completely.
• Good nutrition, including adequate protein and a late-evening snack to protect muscle.
• Careful use of medicines; for example, avoiding anti-inflammatory painkillers such as ibuprofen and using paracetamol at doses advised by your healthcare team.

Even at the cirrhosis stage, weight loss, alcohol avoidance and treating diabetes can slow progression. Liver transplantation is an option for some people with liver failure or early liver cancer.

A note for nurses and healthcare workers

Fatty liver disease is common among healthcare workers too, linked to shift work, irregular meals, stress and limited time for exercise. For nurses supporting patients, key opportunities include identifying people at risk (those with diabetes, obesity or metabolic syndrome), checking that a FIB-4 score or other fibrosis assessment has been done, giving clear and non-judgemental lifestyle advice, supporting realistic weight loss goals, and making sure cardiovascular risk is addressed. Using the new non-stigmatising terms, and avoiding blame, helps patients engage. Nurse-led lifestyle programmes and specialist liver nurses are increasingly central to MASLD care in many countries.

Common myths about fatty liver

• “Fatty liver is harmless.” For many people it remains mild, but for a significant minority it progresses to cirrhosis, and it is linked to heart disease.
• “Only heavy drinkers get liver disease.” Metabolic fatty liver disease is now a leading cause of cirrhosis and liver transplant in many countries.
• “Normal liver blood tests mean my liver is fine.” Liver enzymes can be normal even with significant scarring.
• “Liver detox products will cure it.” There is no evidence for these products, and some can damage the liver.
• “Thin people can’t get fatty liver.” Lean MASLD exists, particularly in some populations.
• “Once you have scarring, it’s permanent.” Early and moderate fibrosis can improve with weight loss and treatment.

Why does fat build up in the liver?

To understand how to reverse fatty liver, it helps to know why fat accumulates in the first place. The liver is the body’s metabolic control centre. It processes nutrients from food, stores energy and releases it when needed. When we eat more energy than we use, especially in the form of sugar and refined carbohydrates, the extra is converted to fat. Normally, much of this fat is stored safely in fat tissue under the skin. But fat tissue has a limited capacity, which varies greatly between people and is influenced by genes and ethnicity. When that capacity is exceeded, fat begins to build up in places it does not belong, including the liver, muscles, pancreas and around the heart.

A key driver is insulin resistance. Insulin is the hormone that helps move sugar from the blood into cells. In insulin resistance, the body’s cells respond poorly to insulin, so the pancreas produces more of it. High insulin levels encourage the liver to make new fat and make it harder for stored fat to be broken down. Fat tissue that is overloaded also releases fatty acids into the bloodstream, which travel to the liver. At the same time, the liver may become less efficient at exporting fat. The result is a liver that steadily fills with fat.

Once fat builds up, some liver cells become stressed. Toxic fat by-products, oxidative stress, signals from the gut and inflammation from fat tissue can all trigger inflammation in the liver. Repeated injury activates cells that lay down scar tissue. This is how simple fatty liver can progress to MASH and fibrosis in susceptible people.

This understanding explains why the most effective treatments target the whole metabolic system: reducing energy intake, especially from sugar; increasing physical activity, which helps muscles use sugar and fat; improving insulin sensitivity; and reducing alcohol, which adds extra load to the liver.

Fatty liver around the world

Fatty liver disease is truly global. The highest rates are reported in the Middle East, North Africa and Latin America, with rapidly rising rates across Asia and sub-Saharan Africa as diets shift towards processed foods and sugary drinks, physical activity falls, and obesity and type 2 diabetes become more common. In many countries, MASLD is now one of the leading reasons for liver transplantation and a growing cause of liver cancer.

In low- and middle-income countries, fatty liver often coexists with other liver conditions, such as hepatitis B and C, and with alcohol use. Access to tests such as FibroScan may be limited, but simple tools such as the FIB-4 score, which uses basic blood tests, can be calculated almost anywhere. Public health measures, such as taxes on sugary drinks, clearer food labelling and creating environments where people can walk and be active, are increasingly recognised as essential to tackling the problem at population level.

A practical week of liver-friendly changes

Big changes can feel overwhelming. Small, steady steps often work better. Here is one way to start:

• Day 1: Replace all sugary drinks with water, sparkling water, unsweetened tea or black coffee.
• Day 2: Add a 15-minute walk after your largest meal.
• Day 3: Make half your plate vegetables at lunch and dinner.
• Day 4: Swap white bread or white rice for a wholegrain option, or reduce the portion by a third.
• Day 5: Plan two alcohol-free days each week, or more if you drink regularly.
• Day 6: Try a simple strength session at home: squats from a chair, wall push-ups and step-ups.
• Day 7: Cook a meal based on beans, lentils or fish with olive oil and plenty of vegetables.

Repeat and build on these changes week by week. Track your weight and waist measurement once a week, rather than daily, to see the overall trend.

Sleep, stress and fatty liver

Short sleep, irregular sleep and night shift work are associated with insulin resistance, weight gain and fatty liver. Chronic stress raises cortisol, which can increase appetite and fat storage around the abdomen. Aim for seven to nine hours of sleep, keep regular sleep times where possible, and build in stress-reducing activities such as walking outdoors, time with friends, prayer or meditation. If you snore loudly or stop breathing in your sleep, ask to be checked for sleep apnoea, which is common in people with fatty liver and can worsen liver damage.

Fatty liver in women, pregnancy and menopause

Women of reproductive age are somewhat protected by oestrogen, but this protection fades after menopause, when rates of fatty liver rise. Women with polycystic ovary syndrome have a higher risk of fatty liver at younger ages because of insulin resistance, so screening and lifestyle support are particularly important for them. During pregnancy, women with pre-existing fatty liver may have a higher risk of gestational diabetes, high blood pressure and pre-eclampsia. Planning pregnancy with a healthcare provider, aiming for a healthy weight beforehand where possible, and close monitoring during pregnancy all help.

A different and rare condition, acute fatty liver of pregnancy, can occur in the third trimester and is a medical emergency. Symptoms include nausea, vomiting, abdominal pain, feeling generally unwell, and yellowing of the skin or eyes. Any pregnant woman with these symptoms should seek urgent care.

Fatty liver and type 2 diabetes: a two-way relationship

Fatty liver and type 2 diabetes are closely connected. Fat in the liver worsens insulin resistance and makes blood sugar harder to control, and diabetes accelerates liver scarring. People with type 2 diabetes are two to three times more likely to have advanced fibrosis than people with fatty liver who do not have diabetes. This is why many guidelines recommend checking every person with type 2 diabetes for liver scarring. The encouraging side of this relationship is that treatments which improve diabetes, including weight loss, physical activity and certain medicines such as GLP-1 receptor agonists, pioglitazone and SGLT2 inhibitors, often improve the liver too. Some people with type 2 diabetes who lose substantial weight early in their condition can put their diabetes into remission and, at the same time, clear most of the fat from their liver.

Medicines and supplements: what to be careful with

People with fatty liver can take most medicines safely, including statins, blood pressure medicines and most diabetes medicines. A few points are worth knowing:

• Paracetamol (acetaminophen) is generally safe at recommended doses for people with fatty liver, and is often preferred over anti-inflammatory painkillers. Never exceed the recommended dose, and take extra care if you drink alcohol or have cirrhosis.
• Anti-inflammatory painkillers such as ibuprofen should be avoided in people with cirrhosis because they can affect kidney function and cause bleeding.
• Herbal and dietary supplements are a growing cause of liver injury worldwide. Products marketed for weight loss, bodybuilding, “detox” and “liver support”, as well as some traditional remedies, have been linked to serious liver damage. Always tell your healthcare provider and pharmacist about any supplements you take.
• Medicines that can cause or worsen fatty liver, such as long-term steroids, should be reviewed regularly, but never stopped without advice.

Tracking your progress

Reversing fatty liver takes time, and it helps to know what to measure:

• Weight and waist circumference: measured weekly or monthly. A shrinking waist is a good sign that abdominal and liver fat are falling.
• Blood tests: liver enzymes, blood sugar (HbA1c) and cholesterol may improve within months, though normal enzymes do not rule out fatty liver.
• Fibrosis scores: FIB-4 or elastography repeated every one to three years, depending on your risk, to check that scarring is not progressing.
• How you feel: many people notice more energy, better sleep and improved mood as they make changes.

Celebrate progress that is not on the scale, such as walking further, cooking more meals at home or cutting out sugary drinks. These are the habits that protect your liver over the long term.

Questions to ask your healthcare provider

• What stage is my fatty liver disease, and has my scarring been assessed?
• What is my FIB-4 score, and do I need a FibroScan or other test?
• How much weight should I aim to lose, and over what time?
• Can I be referred to a dietitian or weight management programme?
• Are any of my medicines affecting my liver?
• Would any diabetes or weight-loss medicines help my liver?
• How much alcohol, if any, is safe for me?
• How often should my liver be checked from now on?
• What is my heart disease risk, and how is it being managed?

Supporting a family member with fatty liver

Lifestyle changes are much easier when the whole household is involved. Cooking healthier meals together, keeping sugary drinks out of the house, going for family walks, and celebrating progress all help. Avoid blame or criticism, which tends to undermine motivation. Remember that fatty liver is influenced by genes, environment and many factors beyond individual control, and that support works far better than shame.

Fatty liver and liver cancer

Hepatocellular carcinoma, the most common type of primary liver cancer, usually develops in livers that are already scarred. Fatty liver disease is now one of the fastest-growing causes of liver cancer in many regions. Most cases occur in people with cirrhosis, which is why six-monthly surveillance is recommended for them. However, a notable share of liver cancers linked to MASLD develop in people without cirrhosis, particularly those with diabetes and obesity. This is another reason to take fatty liver seriously and address metabolic risk factors early. Symptoms of liver cancer can include weight loss, loss of appetite, pain in the upper right abdomen, a lump, and yellowing of the skin, but many early cancers cause no symptoms, which is why surveillance matters for people at high risk.

Gut health and the liver

The liver receives blood directly from the gut through the portal vein, so it is exposed to everything absorbed from the intestine, including bacterial products. Research suggests that changes in the gut microbiome may contribute to liver inflammation in fatty liver disease. A diet rich in fibre from vegetables, fruit, legumes and wholegrains supports a healthy, diverse microbiome and is one more reason that plant-rich eating patterns benefit the liver. Probiotic supplements are being studied, but there is not yet enough evidence to recommend them as a treatment for fatty liver.

What success looks like

People who reverse fatty liver rarely do it through a single dramatic change. They usually build several sustainable habits: fewer sugary drinks and processed foods, more home-cooked meals, more vegetables and legumes, regular walking and some strength work, less alcohol and better sleep. Over a year or two, their weight and waist size fall, blood sugar improves, liver fat decreases, and follow-up tests show that scarring has stopped progressing or has improved. Just as importantly, their risk of heart disease and diabetes falls at the same time. Fatty liver can be a turning point: an early warning that, when acted on, protects not just the liver but the whole body.

Eating out, celebrations and cultural foods

Food is central to family life, culture and celebration, and a fatty liver diagnosis should not mean giving up the dishes you love. Instead, look for ways to adapt them. Use less oil when frying, or bake, grill and steam more often. Serve smaller portions of rice, bread, pasta, fufu, chapati or other staples, and add extra vegetables or legumes alongside. Choose lean meats and fish, and remove visible fat and skin. At celebrations, fill your plate with salads and grilled items first, drink water between any alcoholic drinks, and skip sugary punches and sodas. When eating out, ask for sauces on the side, choose grilled rather than fried options, and share desserts. Enjoying food with others is good for wellbeing; the goal is balance, not deprivation.

Fatty liver and work

Long working hours, sedentary jobs, night shifts and workplace food environments full of snacks and sugary drinks all make fatty liver more likely. Simple workplace habits help: bring a packed lunch, keep water at your desk or station, take the stairs, walk during breaks, and avoid using vending machines as your main source of food on long shifts. Employers can help too, by providing healthy food options and spaces for activity.

Frequently asked questions

Can fatty liver be reversed?

Yes, especially in the early stages. Weight loss of 7 to 10 percent can reduce fat and inflammation, and greater loss can reverse scarring in many people.

How long does it take to reverse fatty liver?

Liver fat can start to fall within weeks of changing diet and activity. Improvements in inflammation and scarring take months to years of sustained change.

Is fatty liver disease serious?

It can be. The risk depends mainly on the amount of scarring. Ask for a fibrosis assessment.

What should I avoid eating with fatty liver?

Limit sugary drinks, added sugars, refined carbohydrates, ultra-processed foods, saturated fat and alcohol.

Can I drink alcohol with fatty liver?

Keep alcohol low, and avoid it completely if you have significant scarring or cirrhosis.

Does fatty liver cause weight gain?

Fatty liver itself does not cause weight gain, but it is linked to insulin resistance, which can make weight management harder.

But what if I have tried to lose weight and failed?

Weight loss is hard, and most people need more than willpower. Ask your healthcare provider about structured support, such as a weight management programme, a dietitian, or medicines for weight loss and diabetes that also help the liver. Focus on changes that help your liver even if the scale moves slowly: cutting sugary drinks, eating more vegetables and legumes, walking daily, reducing alcohol and improving sleep. These still reduce liver fat. Every step counts.

Related: Type 2 diabetes: the complete guide · Weight management: the complete guide

Sources: European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), Latin American Association for the Study of the Liver (multisociety nomenclature consensus 2023), EASL-EASD-EASO clinical practice guidelines on MASLD, World Health Organization, Global Burden of Disease Study, MAESTRO-NASH and ESSENCE trials.