Health condition · Clinically reviewed
Fatty liver disease (MASLD), the UK’s most common liver disease.
Metabolic dysfunction-associated steatotic liver disease (formerly NAFLD/NASH). Common, largely silent — but progressive. FibroScan, lifestyle and new pharmacotherapies are transforming care.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, EASL and British Liver Trust sources you can see at the end.
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Current for 2026
Reflects the 2023 NAFLD → MASLD renaming, FibroScan-led pathways and new GLP-1 and liver-directed pharmacotherapies.
Key facts
Fatty liver disease at a glance.
The essentials, in plain English — what MASLD is, how it progresses, how it is assessed, and what actually reverses it.
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What it is
Metabolic dysfunction-associated steatotic liver disease (MASLD) — fat build-up in the liver driven by insulin resistance and the metabolic syndrome.
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New name (2023)
The 2023 renaming from NAFLD to MASLD reflects the metabolic focus and removes the outdated ‘non-alcoholic’ framing.
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How common
Affects around 30% of UK adults — the country’s most common liver disease.
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How it progresses
Steatosis → MASH (steatohepatitis) → fibrosis → cirrhosis. Most people never progress, but a meaningful minority do.
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How it is assessed
FibroScan (transient elastography) is the standard non-invasive test for liver stiffness, alongside FIB-4 or NAFLD fibrosis score.
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What reverses it
Weight loss of 7-10% reverses much of the disease — including a large proportion of fibrosis in early stages.
Why this guide matters
A silent disease that is finally getting the attention it deserves.
MASLD care in 2026 looks nothing like it did a decade ago. The three points below shape everything else on this page.
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Reversibility is real
A 7-10% weight loss reverses much of the disease — especially fibrosis in earlier stages.
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FibroScan changed the pathway
Non-invasive elastography now identifies who needs specialist care without a biopsy.
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The drugs are catching up
GLP-1s and the first liver-directed agent (resmetirom) have shifted what treatment looks like.
How the diagnosis is made
From risk cluster to a clear plan.
The steps a UK GP will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Risk cluster, LFTs and ultrasound
Phase 2 · Confirming
FIB-4 and FibroScan for fibrosis
Phase 3 · Managing
Biopsy if needed and hepatology
- 01
Recognising
Recognise the metabolic risk cluster
Central obesity, type 2 diabetes, dyslipidaemia and hypertension together should prompt a liver check.
- 02
Recognising
LFTs (liver function tests)
ALT is often mildly raised — but normal LFTs do not exclude MASLD.
- 03
Recognising
Ultrasound for steatosis
A first-line scan showing fatty change in the liver — widely available and quick.
- 04
Confirming
FIB-4 or NAFLD fibrosis score
A simple blood-and-age calculation that flags who needs further fibrosis assessment.
- 05
Confirming
FibroScan (transient elastography)
The standard non-invasive test for liver stiffness — the modern gateway to hepatology referral.
- 06
Managing
Liver biopsy only if uncertain
Reserved for diagnostic uncertainty or clinical-trial eligibility — not routine.
- 07
Managing
Hepatology referral if F2+ fibrosis
Significant fibrosis warrants specialist review, surveillance and access to newer therapies.
Typical timeline: 4-8 weeks from first blood test to a settled plan.
Symptoms
What fatty liver actually looks like.
Almost always silent — which is exactly why the metabolic risk cluster matters so much. Here is what to watch for.
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Asymptomatic (usual)
Most people feel nothing at all — MASLD is typically found on a scan or blood test done for another reason.
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Central obesity
Waist-heavy weight distribution is the single most common physical clue.
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Type 2 diabetes
Diabetes and MASLD travel together — up to 70% of people with T2D have fatty liver.
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Dyslipidaemia
Raised triglycerides and low HDL cholesterol are common companions.
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Hypertension
High blood pressure is part of the same metabolic cluster driving MASLD.
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Persistently raised ALT
A mildly elevated ALT that does not settle deserves a fatty-liver work-up.
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Family history
MASLD, T2D and cardiovascular disease in first-degree relatives all raise your risk.
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Cirrhosis complication
Varices, ascites or encephalopathy — any of these needs urgent same-day assessment.
Treatment
How MASLD is treated in the UK.
Lifestyle first, then the drug classes that do the most — what each option does, and where it fits.
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7-10% weight loss (mainstay)
Sustained loss of 7-10% of body weight reverses steatosis in most and improves fibrosis in many.
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Mediterranean diet
The best-evidenced eating pattern for MASLD — olive oil, fish, vegetables, nuts, whole grains.
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Structured exercise
150 minutes/week of moderate activity plus resistance training — independent liver-fat reduction, even without weight loss.
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GLP-1 receptor agonist
Semaglutide and tirzepatide drive weight loss and improve MASH — increasingly used where BMI and diabetes indications allow.
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Resmetirom (specialist)
A liver-directed THR-β agonist approved in the US for MASH with F2-F3 fibrosis — UK pathway pending.
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Optimise T2DM
SGLT2 inhibitors and GLP-1 receptor agonists lower liver fat as well as glucose — favoured drug classes.
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Alcohol reduction
Even ‘non-alcoholic’ fatty liver worsens with alcohol — keep intake low, and abstain if fibrosis is significant.
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Hepatology follow-up
For anyone with F2 or greater fibrosis — surveillance, cardiovascular risk work and access to trials.
What this guide is based on
The sources behind every number on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or hepatology team knows your history and can tell you which parts apply to you. If in doubt, ask them.
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NICE. Non-alcoholic fatty liver disease (NAFLD): assessment and management (NG49).
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EASL-EASD-EASO. 2024 clinical practice guideline on the management of MASLD.
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British Liver Trust. Patient information on fatty liver disease.
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AASLD. 2023 multi-society consensus paper on new MASLD nomenclature.
Red flags
When fatty liver disease becomes an emergency.
Most of the time MASLD is a slow burn. These are the situations where it stops being slow — and you should act today.
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Ascites
Fluid in the abdomen — a sign of decompensated cirrhosis. Urgent assessment.
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Variceal bleeding
Vomiting blood or black stools with known liver disease — 999.
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Encephalopathy
Confusion, disorientation or drowsiness in someone with liver disease — urgent.
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Rapid ALT rise
A sharp jump in liver enzymes deserves same-week review to exclude other causes.
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Jaundice
Yellowing of the skin or eyes — urgent liver assessment.
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Post-liver-transplant care
MASLD can recur in a transplanted liver — specialist follow-up is essential.
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Coexisting hepatitis
Hepatitis B or C alongside MASLD accelerates progression — needs joint specialist care.
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Alpha-1 antitrypsin deficiency
An inherited condition that mimics or compounds MASLD — worth testing when clinical picture is unusual.
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HCC surveillance in cirrhosis
Anyone with MASLD-cirrhosis needs 6-monthly ultrasound to screen for liver cancer.
Living with it
A long-term condition, but a very reversible one.
Four things that make the biggest difference day to day — food, activity, reviews and mental health.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Food
Mediterranean, not restrictive
Building meals around vegetables, olive oil, fish and whole grains does more than any single ‘cut this out’ rule.
- 02 Activity
Move most days
Even without weight loss, 150 minutes of moderate activity a week meaningfully reduces liver fat.
- 03 Reviews
Annual metabolic MOT
BP, HbA1c, cholesterol, weight and — when indicated — a repeat FibroScan keep the picture current.
- 04 Mental health
A silent diagnosis is heavy
Being told your liver has a problem when you feel well can be unsettling. Support is available — ask.
Frequently asked
Everything we get asked about MASLD.
Quick answers on FibroScan, reversibility, GLP-1 medications and when to worry.
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What is MASLD?
Metabolic dysfunction-associated steatotic liver disease — the 2023 renaming of NAFLD. It describes fat build-up in the liver driven by insulin resistance and the metabolic syndrome, rather than by alcohol.
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How is fatty liver diagnosed?
Usually with a combination of blood tests (LFTs, FIB-4 score), ultrasound to see the fat, and a FibroScan to measure liver stiffness. A biopsy is only needed if there is diagnostic uncertainty or as part of a trial.
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What is a FibroScan?
A quick, non-invasive scan (transient elastography) that measures how stiff your liver is — a proxy for how much fibrosis is present. It takes about 10 minutes and does not need any preparation beyond a light fast.
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Can fatty liver be reversed?
Yes, in most people — a sustained weight loss of 7-10% reverses much of the fat and can improve or reverse early fibrosis. The earlier you act, the more reversible it is.
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Do GLP-1 drugs help fatty liver?
Yes — semaglutide and tirzepatide drive significant weight loss and have shown improvement in MASH in trials. They are increasingly used where diabetes or BMI criteria are met.
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When should I be worried?
Any sign of decompensated liver disease — jaundice, confusion, fluid in the abdomen, or vomiting blood — needs urgent assessment. A rapid rise in liver enzymes also warrants same-week review.
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