Fatty liver disease (MASLD, previously NAFLD)
Also called: fatty liver, non-alcoholic fatty liver disease, NAFLD, metabolic dysfunction-associated steatotic liver disease, MASLD, steatotic liver disease
Fatty liver disease means too much fat has built up in the liver, usually linked to extra body weight, diabetes, high blood pressure or high cholesterol. Most people have no symptoms. Losing weight, eating well and being active can reduce the fat and stop damage getting worse.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Fatty liver disease is a common condition in which fat builds up inside the liver. A liver is called fatty when more than about 5 in every 100 parts of it is fat. Doctors now often call it metabolic dysfunction-associated steatotic liver disease (MASLD). Its older name is non-alcoholic fatty liver disease (NAFLD). "Steatotic" simply means fatty. The new name points to the real driver: problems with how the body handles sugar and fat, such as being overweight, type 2 diabetes, high blood pressure or high cholesterol.
The condition has stages. Most people only ever have fat in the liver without damage. In some people the fat causes inflammation (swelling and irritation), called MASH (previously NASH). Over years this can lead to scarring (fibrosis) and, in a smaller number, severe scarring (cirrhosis), which can stop the liver working properly.
Most people feel well, so fatty liver is often found by chance on a blood test or scan done for another reason. People with fatty liver also have a higher risk of heart disease. The main treatment is lifestyle change: losing weight if you are overweight, eating a healthier diet, being more active and keeping alcohol low. These steps can reduce liver fat and help the liver repair itself.
In Pakistan
A 2024 review of 34 studies from Pakistan estimated that about 3 in 10 people in the general population have fatty liver disease, rising to nearly 6 in 10 people with diabetes and almost half of people with obesity.
Symptoms
- Usually no symptoms at all; it is often found by chance on a blood test or scan
- Feeling very tired
- Feeling generally unwell
- Pain or discomfort in the upper right side of the tummy, under the ribs
- Bloating or poor sleep in some people
- A slightly enlarged liver that a doctor may feel when examining you
- In children: tummy pain, tiredness, or dark, thick patches of skin on the neck or armpits (acanthosis nigricans)
- In advanced disease: yellow skin or eyes (jaundice), itching, swelling of the legs or tummy, confusion or easy bleeding
Causes and risk factors
Causes
- Fat building up in the liver when the body takes in more energy from food than it needs
- Insulin resistance (the body does not respond well to the hormone insulin), which is linked to being overweight and type 2 diabetes
- Being overweight or obese, the most common reason for fat in the liver
- Diets high in refined sugar and fatty foods
- Genes play a small part, so the condition can run in families
- Doctors also check for other causes of a fatty liver, such as heavy drinking, hepatitis C and some medicines (for example amiodarone, methotrexate, tamoxifen, steroids and valproate); never stop a medicine without asking your doctor
What makes it more likely
- Being overweight, especially carrying fat around the waist and tummy
- Type 2 diabetes or prediabetes
- High blood pressure
- High cholesterol or high triglycerides (blood fats)
- Polycystic ovary syndrome (PCOS)
- An unhealthy diet and little physical activity
- Being over 50
- Having a close family member with the condition
Complications
Most people with fatty liver never develop serious liver problems. In some, the fat leads to inflammation (MASH), and about 1 in 5 of these people may go on to develop cirrhosis (severe scarring). Cirrhosis can cause bleeding inside the body, liver failure, liver cancer and serious infection, and a few people need a liver transplant. Fatty liver also raises the risk of type 2 diabetes, high blood pressure and chronic kidney disease. Heart disease is the most common cause of death in people with fatty liver. In people with type 2 diabetes, it is linked to a higher risk of heart attack, stroke and an irregular heartbeat called atrial fibrillation.
When to see a doctor
- Yellow skin or yellow whites of the eyes (jaundice)
- A swollen tummy or swollen legs from fluid build-up
- New confusion, drowsiness or memory problems
- Vomiting blood or any unusual bleeding or bruising
- Severe itching together with other signs of liver problems
- If someone is very confused, vomiting blood or hard to wake, seek emergency care straight away
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Diagnosis
Fatty liver is usually found after blood tests or a scan done for another reason. Your doctor will ask about your health and how much alcohol you drink, and measure your weight, height and waist. Further blood tests help rule out other liver diseases, such as viral hepatitis, and check for related problems like diabetes and kidney disease. An ultrasound scan of the tummy can show fat in the liver. Normal liver blood tests do not rule out fatty liver.
Everyone with fatty liver should be checked for liver scarring. This is done with special blood tests, such as the enhanced liver fibrosis (ELF) test or a FIB-4 score, and sometimes with a scan that measures liver stiffness (elastography). If the result shows little risk, the test is usually repeated every few years. People with advanced scarring are referred to a liver specialist. A liver biopsy (taking a tiny piece of liver to look at) is only needed when other tests are unclear. Children with type 2 diabetes or metabolic syndrome may be offered an ultrasound and are referred to a children's liver specialist if fatty liver is suspected.
Treatment
- Change your lifestyle first: eat a healthy, balanced diet, aim for at least 150 minutes of activity a week, and lose weight slowly if you are overweight; losing about a tenth of your body weight can reduce liver fat and inflammation
- Keep alcohol as low as possible, ideally none, and stop smoking
- Get diabetes, blood pressure and cholesterol well controlled; if you take a statin, keep taking it
- Have regular check-ups and repeat tests for liver scarring as your doctor advises
- If tests show advanced scarring, a liver specialist will look after you and may consider pioglitazone or vitamin E; pioglitazone is not used in people with heart failure or a history of bladder cancer
- If you have obesity, a specialist may suggest weight-loss medicines or weight-loss surgery
- People with cirrhosis need regular specialist monitoring, including checks for liver cancer
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Statins (cholesterol-lowering medicines) | lower cholesterol and protect the heart; they are safe in fatty liver and should be continued, and your doctor will only review them if liver blood tests rise sharply soon after starting | Atorvastatin (86 brands), Rosuvastatin (6 brands), Simvastatin (121 brands) |
| Biguanide diabetes medicine | first-choice medicine to control blood sugar in people who also have type 2 diabetes; it treats diabetes, not liver fat itself, and is not used in advanced cirrhosis with liver failure | Metformin (152 brands) |
| Fish oil fatty acid supplements | NICE advises that these fatty acid supplements are not offered to adults for fatty liver because there is not enough evidence that they help | Chosen by your specialist |
Also used (not yet in our price list): Pioglitazone (specialist use only, for advanced liver scarring), Vitamin E (specialist use only, for advanced liver scarring)
Self-care and prevention
Self-care
- Fill half your plate with vegetables and fruit, a quarter with whole grains and a quarter with protein
- Drink water instead of juice or sugary drinks
- Cut down on added sugar, processed snacks and fried or fatty foods
- Be active most days, aiming for 150 to 300 minutes a week; walking counts
- Lose weight gradually if you are overweight; a food diary or a dietitian can help
- Avoid alcohol if you can, and do not smoke
- Take your medicines for diabetes, blood pressure and cholesterol as prescribed
- Go to your check-ups, even if you feel well
Prevention
- Keep to a healthy weight, especially around the waist
- Eat a balanced diet low in added sugar and fried food
- Stay physically active
- Keep alcohol low
- If you have diabetes, high blood pressure or high cholesterol, ask your doctor about checking your liver
Common questions
Can fatty liver be reversed?
Yes, often. Simple fatty liver usually gets better when you lose weight, eat a healthier diet and become more active. These changes reduce liver fat and can help the liver repair some damage. Even if there is scarring, lifestyle change can slow or stop it getting worse.
Is fatty liver dangerous?
Most people only have fat in the liver and never develop serious liver damage. A smaller number develop inflammation and scarring, which can lead to cirrhosis over many years. Fatty liver also raises the risk of heart disease, so looking after your heart matters too.
What is the difference between NAFLD and MASLD?
They describe the same condition. MASLD (metabolic dysfunction-associated steatotic liver disease) is the newer name. It replaces NAFLD to make clear that the cause is linked to weight, blood sugar, blood pressure and cholesterol, rather than just the absence of heavy drinking.
Can I drink alcohol if I have fatty liver?
It is best to drink as little as possible, and to avoid alcohol completely if you can. Alcohol adds extra strain on a liver that is already affected. Ask your doctor what is safe for you, especially if you have scarring.
Is there a medicine for fatty liver?
Lifestyle change is the main treatment. For people with advanced scarring, a liver specialist may consider pioglitazone or vitamin E. Medicines for diabetes, blood pressure and cholesterol are also important, and statins are safe to take.
Sources
- NHS. Non-alcoholic fatty liver disease (NAFLD) - NHS (2025).
- NICE. Non-alcoholic fatty liver disease (NAFLD): assessment and management (NICE guideline NG49) - Recommendations (2016).
- American College of Gastroenterology (ACG). Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) | ACG (2025).
- StatPearls (NCBI Bookshelf). Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) (2025).
- MedlinePlus. Metabolic dysfunction-associated steatotic liver disease: MedlinePlus Genetics (2026).
- Scientific Reports (via DOAJ). Prevalence of nonalcoholic fatty liver disease in Pakistan: a systematic review and meta-analysis (2024).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Type 2 diabetes mellitusHigh cholesterol (dyslipidaemia)High blood pressure (hypertension)