MASLD is the modern name for what many patients know as “non-alcoholic fatty liver disease”. The term highlights its link with metabolic dysfunction: abdominal obesity, insulin resistance, prediabetes, type 2 diabetes, high triglycerides or hypertension.
Why does fatty liver matter?
Fatty liver causes no symptoms in many people. However, in some patients it can progress to liver inflammation (MASH), fibrosis, cirrhosis or liver complications. The risk is greater when type 2 diabetes, obesity or metabolic syndrome is present.
Which tests may raise suspicion?
Liver tests such as ALT, AST and GGT may be abnormal, but can also be normal in some situations. The doctor therefore does not rely on transaminases alone. The following may be useful:
- ALT, AST, GGT, bilirubin, albumin and platelets;
- blood glucose, HbA1c and lipid profile;
- abdominal ultrasound;
- non-invasive fibrosis scores, calculated by the doctor from test results and age;
- elastography if there is a high risk of fibrosis.
If an ultrasound report mentions “hepatic steatosis”, “fatty liver” or “fat accumulation in the liver”, it is worth discussing the result in a metabolic context as well as a liver context.
The link with diabetes and weight
Type 2 diabetes and abdominal obesity are among the most important factors associated with the progression of MASLD. In practice, fatty liver can be a sign that the body is having difficulty managing energy, fats and glucose.
Management therefore often includes the same strategy used for prediabetes and metabolic syndrome: nutrition, weight loss when necessary, physical activity and control of blood pressure, glucose and lipids.
Which changes help?
- gradual, supervised weight loss if there is excess weight;
- reducing sweetened drinks and excessive alcohol;
- meals based on vegetables, protein, pulses, wholegrains and unsaturated fats;
- regular physical activity combining brisk walking with strength exercises;
- monitoring diabetes, blood pressure and the lipid profile.
For a practical strategy, see the Mediterranean diet for diabetes and weight loss and the page on medically supervised weight loss.
When should you seek help?
If you have diabetes, obesity, high triglycerides or abnormal transaminases, do not put off assessment. A diabetes consultation or test interpretation can clarify what needs monitoring and which steps have priority.
