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Fatty liver disease means excess fat has built up in the liver. The metabolic form is now called metabolic dysfunction-associated steatotic liver disease (MASLD); when it also involves inflammation and liver-cell injury, it is called metabolic dysfunction-associated steatohepatitis (MASH). Many people have no symptoms, so what happens next depends less on how they feel than on whether testing finds liver scarring.
What does “fatty liver disease” mean?
“Fatty liver disease” is a broad description, not a complete diagnosis or a single stage of illness. MASLD is the current name for the metabolic form, associated with cardiometabolic risk. MASH is its inflammatory form. You may still encounter the older terms nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) in earlier test results, medical records, patient materials, or some FDA labeling. The newer terminology is explained in the 2024 EASL–EASD–EASO clinical guideline.
Alcohol-associated liver disease and other causes of liver fat are distinct possibilities. A clinician may consider alcohol intake, medicines, and other liver conditions when evaluating a finding of fat in the liver; the finding alone does not establish its cause.
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Symptoms are an unreliable guide
Fatty liver often causes no noticeable symptoms. Some people report fatigue or discomfort in the upper-right abdomen, but neither is specific enough to diagnose the condition. Feeling well also cannot rule out liver scarring.
What causes fatty liver, and who can develop it?
Fat accumulation is associated with several interacting factors, and the causes are still being studied. Commonly associated factors include overweight or obesity, insulin resistance or type 2 diabetes, high triglycerides or abnormal cholesterol, metabolic syndrome, physical inactivity, and dietary patterns. Genetics and other biological factors may contribute too.
These are risk associations, not a checklist that every person must meet: someone can develop fatty liver without obesity or alcohol use. Alcohol, some medicines, and other liver diseases may also be relevant to an individual’s evaluation. A clinician considers the full medical history rather than inferring a cause from body weight or a scan alone.
What are the stages of fatty liver disease?
The terms below describe a possible course, not an inevitable sequence or a timetable. Many people do not develop advanced fibrosis, and an individual’s outlook cannot be determined from symptoms or one routine test result. The NHS overview describes the progression in patient-facing terms.
| Stage or finding | What it means |
|---|---|
| Steatosis | Excess fat is present in the liver, without the inflammatory injury described in MASH. |
| MASH (formerly NASH) | Fat is accompanied by inflammation and liver-cell injury; scarring may develop. |
| Fibrosis | Scar tissue has accumulated. Its degree is important in assessing the risk of more serious disease. |
| Cirrhosis | Extensive, advanced scarring can impair liver function and lead to complications, including liver failure and liver cancer. |
Fat in the liver, MASH, fibrosis, and cirrhosis are not interchangeable terms. In particular, finding fat does not by itself mean a person has inflammation, significant scarring, or cirrhosis.
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How do clinicians assess fatty liver and its severity?
Fatty liver may first be noticed incidentally on blood tests or imaging. To understand what the finding means, clinicians review medical history, physical findings, metabolic risks, alcohol intake, medicines, and other possible causes. Blood tests and imaging can contribute, but a liver enzyme result alone does not establish the full diagnosis or stage.
Assessing fibrosis
A practical question is whether there is significant fibrosis and whether more assessment is needed. Clinicians may calculate a non-invasive fibrosis score such as FIB-4 and, when indicated, use imaging such as transient elastography. A liver biopsy can clarify disease features in selected cases; it is not an inevitable step for everyone. See the NIDDK explanation of NAFLD and NASH diagnosis for more on the assessment process.
What happens next after a fatty liver finding?
Next steps depend on the likely cause, overall health, and fibrosis assessment. For many people, care includes gradual, sustainable changes to eating habits and physical activity, alongside management of relevant metabolic health risks. A finding on a scan is a reason to discuss appropriate evaluation with a clinician, not a basis for choosing a medicine on its own.
Lifestyle measures and weight loss
For people for whom weight loss is appropriate, NIDDK gives population-level guidance that losing at least 3% to 5% of body weight can reduce liver fat; some people may need to lose 7% to 10% to reduce liver inflammation and fibrosis. These are not personal targets or guarantees. Physical activity may help even without weight loss. Weight loss should be gradual: rapid loss and malnutrition can worsen liver disease. The NIDDK treatment overview discusses these measures and their limits.
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Prescription options for a defined group in the United States
As of October 4, 2026, current U.S. FDA labeling includes resmetirom (Rezdiffra) and semaglutide (Wegovy) for adults with noncirrhotic MASH and moderate-to-advanced fibrosis (F2–F3), alongside diet and exercise. These prescription options are for a defined group, not for everyone with liver fat. Eligibility, risks, current labeling, and availability depend on the patient and jurisdiction; a clinician must assess whether either option applies. U.S. approval should not be assumed to mean authorization elsewhere. The FDA provides 2026 U.S. prescribing information for resmetirom and its 2025 announcement of semaglutide approval for MASH.
In its March 14, 2024 announcement of Rezdiffra, the FDA described it as the first treatment option for patients with liver scarring due to fatty liver disease “in addition to diet and exercise.” The agency’s announcement attributes that statement to Nikolay Nikolov, M.D., then acting director of FDA’s Office of Immunology and Inflammation in the Center for Drug Evaluation and Research.
Supplements and “detox” products
“Liver detoxes” and supplements are not substitutes for medical assessment or treatment. NIDDK advises discussing supplements with a clinician because some herbal remedies can damage the liver.
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The FDA’s 2025 semaglutide-approval announcement estimated that 14.9 million people—approximately 6% of U.S. adults—have MASH. This is an FDA-reported U.S. adult estimate for MASH, not a global figure and not the prevalence of all uncomplicated liver fat.
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