What is fatty liver disease?

How MASLD Can Progress

Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is a common liver condition in which excess fat builds up in the liver. For many people, MASLD may remain stable for years, but in some individuals it can progress to more serious liver disease.

This illustration shows the potential stages of progression, beginning with a healthy liver and moving through MASL, MASH, fibrosis, cirrhosis, and, in some people with advanced liver disease, hepatocellular carcinoma (HCC), the most common form of primary liver cancer.

One of the challenges with MASLD is that people can have significant liver fat or even liver damage without obvious symptoms. This is why understanding your risk and identifying liver disease early are so important.

The key message is that progression is not inevitable. 

Not everyone moves through each stage, and the disease can remain stable or improve, particularly when metabolic risk factors are addressed. Lifestyle changes, management of conditions such as type 2 diabetes, obesity, high blood pressure and abnormal cholesterol, appropriate medical treatment when indicated, and regular follow-up with a healthcare professional can all play an important role in protecting liver health.

If you have risk factors for MASLD or are concerned about your liver health, speak with your healthcare professional about whether a liver health assessment is appropriate for you.

Protecting Your Liver Before Disease Develops

A healthy liver contains little to no excess fat, significant inflammation, or scarring. 

Although we often think about the liver only when something goes wrong, it performs hundreds of essential functions every day, including processing nutrients, producing bile, filtering the blood, storing energy, and helping regulate blood sugar and cholesterol.

Most people with a healthy liver have no liver-related symptoms, and routine liver tests are often normal. 

However, maintaining liver health is especially important for people with metabolic risk factors such as excess weight, type 2 diabetes, high blood pressure, or abnormal cholesterol.

Protecting your liver involves many of the same steps that support your overall metabolic and cardiovascular health. Eating a balanced diet, being physically active, maintaining a healthy weight, limiting alcohol, getting adequate sleep, and managing blood sugar, blood pressure, and cholesterol can all contribute to long-term liver health.

Regular healthcare visits also provide an opportunity to review your individual risk factors. Depending on your health history, your healthcare professional may recommend blood tests or a non-invasive liver assessment such as ultrasound or Transient Elastography.

The key message is to think about liver health before symptoms appear.

 MASLD can develop silently, so understanding your metabolic risk and taking action early may help prevent or reduce the risk of progression along the MASLD pathway.

Your liver plays an important role in your overall health. Small, sustainable choices today can help protect it for the future.

When Liver Fat Is Joined by Inflammation and Liver-Cell Injury

Metabolic dysfunction-Associated Steatohepatitis (MASH) is a more active form of metabolic liver disease. At this stage, excess fat in the liver is accompanied by inflammation and liver-cell injury. Early scar tissue may also begin to develop.

MASH is commonly associated with metabolic risk factors such as excess weight, insulin resistance, type 2 diabetes, high cholesterol, and high triglycerides. Importantly, many people with MASH may still have few or no obvious symptoms, even while liver injury is occurring.

This makes appropriate assessment particularly important. Healthcare professionals may review metabolic risk factors, perform blood tests, and use non-invasive assessments such as ultrasound or Transient Elastography to evaluate liver fat and stiffness. Additional testing may be recommended depending on an individual's results and risk.

MASH does not mean that progression to advanced liver disease is inevitable.

 However, ongoing inflammation and liver-cell injury can increase the risk of developing significant fibrosis, cirrhosis, and other liver-related complications over time.

This is why early action matters. Weight loss when appropriate, balanced nutrition, regular physical activity, management of blood sugar, blood pressure and cholesterol, limiting alcohol, and ongoing medical follow-up can help improve metabolic and liver health. Medical treatment may also be appropriate for some people with MASH.

The key message is that feeling well does not necessarily mean the liver is healthy. 

Identifying MASH and understanding the degree of fibrosis can provide an important opportunity to intervene before more advanced liver damage develops.

If you have MASLD or metabolic risk factors, talk with your healthcare professional about your individual risk and whether further liver assessment is appropriate.

When Liver Scarring Becomes More Significant

MASH with F2 or F3 fibrosis represents a more advanced stage of metabolic liver disease. Ongoing inflammation and liver-cell injury have caused scar tissue, known as fibrosis, to develop and spread through the liver. Cirrhosis has not yet developed, making this an especially important stage for intervention.

Fibrosis can progress silently. Many people with significant liver fibrosis continue to feel well and may have few or no noticeable symptoms. 

Others may experience fatigue, low energy, difficulty concentrating, or discomfort in the upper right abdomen. 

Liver enzymes may be elevated, but blood tests alone cannot determine the amount of fibrosis present.

Healthcare professionals can assess fibrosis risk using blood-based tools such as FIB-4 together with non-invasive liver assessments such as Transient Elastography or other forms of elastography. In some circumstances, additional testing or a liver biopsy may be needed to better understand the stage of disease.

The amount of fibrosis is one of the most important indicators of future liver-related risk. 

Without appropriate management, F2 or F3 fibrosis can progress to cirrhosis and increase the risk of serious liver complications.

There is also important reason for optimism. At this stage, progression may be slowed or stopped, and fibrosis can sometimes improve. Weight loss when appropriate, regular physical activity, healthy nutrition, management of diabetes, blood pressure and cholesterol, and ongoing medical follow-up are important parts of care. 

Approved medical treatments may also be appropriate for some people with MASH and fibrosis.

The key message is that significant fibrosis is serious, but cirrhosis has not yet developed. 

Identifying F2 or F3 fibrosis creates an important opportunity to intervene, address metabolic risk factors, discuss available treatment options, and closely monitor liver health.

If you have been diagnosed with MASH and fibrosis, talk with your healthcare professional about your fibrosis stage, treatment options, appropriate monitoring, and the steps you can take to protect your liver.