Love Your Liver Part 1: Understanding ‘Fatty Liver’, MASLD & What Your Test Results Indicate.
Recently Been Told You Have Fatty Liver? This Is a Great Place to Start.
Being told you have fatty liver may feel confronting — especially if it was discovered unexpectedly on an ultrasound or your liver enzymes were only mildly elevated. You may have been given some initial advice and told that lifestyle changes can help, but still have questions about what fatty liver means and what to do next.
The good news is that fatty liver exists on a spectrum. When identified early, there is often a great deal that can be done to reduce liver fat and improve metabolic health.
Fatty liver is closely connected with how the body regulates blood sugar, blood fats, inflammation and energy storage. For women, the hormonal and metabolic changes that occur during perimenopause and beyond may also increase susceptibility to liver fat accumulation.
This first article in the three-part Love Your Liver series explains what fatty liver is, why its name has changed from NAFLD to MASLD, and how blood tests, ultrasound and FibroScan may be used to assess liver health.
What Does the Liver Actually Do?
The liver is one of the body’s major metabolic organs. It helps regulate blood sugar, cholesterol and triglycerides, produces bile to support fat digestion, stores important nutrients, processes alcohol and medications, and plays a central role in immune signalling and hormone metabolism.
Because the liver is so closely involved in metabolism, it can also respond positively to changes in diet, movement, body composition, insulin sensitivity and alcohol intake.
What Is Fatty Liver?
Fatty liver means that excess fat has accumulated within liver cells. This is also known as hepatic steatosis.
For many people, fatty liver represents an early and modifiable metabolic warning sign. In some cases, further assessment may be needed to determine whether inflammation or fibrosis is also present.
It is helpful to think of fatty liver disease as a spectrum:
Steatosis, sometimes called simple fatty liver, means there is excess fat within the liver.
MASLD stands for metabolic dysfunction-associated steatotic liver disease. It is diagnosed when liver fat is present alongside at least one cardiometabolic risk factor.
MASH stands for metabolic dysfunction-associated steatohepatitis. This is a more inflammatory form of MASLD in which liver-cell injury is also present.
Fibrosis refers to the development of scar tissue within the liver. Earlier fibrosis may improve in some people, while more advanced fibrosis requires closer medical assessment and monitoring.
Cirrhosis is advanced liver scarring and requires specialist medical care.
Why Did the Name Change From NAFLD to MASLD?
You may still see fatty liver referred to as NAFLD, which stands for non-alcoholic fatty liver disease. This term was used for many years, but it defined the condition by what it was not — primarily caused by high alcohol intake — rather than recognising the metabolic factors commonly associated with it.
This does not mean alcohol is irrelevant. Alcohol can still contribute to liver fat and liver stress. However, for many people, fatty liver is part of a broader metabolic pattern rather than an isolated liver problem.
The newer term, MASLD, places greater emphasis on metabolic dysfunction. This reflects its common links with insulin resistance, abdominal adiposity, elevated blood glucose or triglycerides, high blood pressure and broader cardiovascular risk. You can read more about metabolic health in my article Metabolic Syndrome: Why It Matters And How To Reduce Your Risk Factors and on my Cardiometabolic Health Page.
How Is Fatty Liver Assessed?
Fatty liver cannot be diagnosed or ruled out from liver enzymes alone. Blood tests provide useful information, but they do not directly measure how much fat is present in the liver or reliably determine whether fibrosis is present.
Some people with fatty liver have elevated liver enzymes, while others have liver enzymes within the reference range despite fatty changes being present on imaging. Mildly elevated liver enzymes also do not automatically mean that significant liver damage has occurred.
Your GP or specialist may assess:
liver enzymes such as ALT, AST and GGT
cholesterol and triglycerides
fasting blood glucose and HbA1c
blood pressure, waist circumference and other cardiometabolic risk factors
These results need to be considered alongside your medical history, imaging and, where appropriate, fibrosis assessment. Other possible contributors to abnormal liver results or liver fat should also be considered rather than assuming every case is caused by MASLD.
Ultrasound, FibroScan and Other Liver Assessments
A standard abdominal ultrasound is often the first imaging test to identify fatty liver. It is accessible and non-invasive and can also assess nearby structures, including the gallbladder and bile ducts.
However, ultrasound may not detect milder amounts of liver fat and cannot reliably determine whether liver inflammation or fibrosis is present.
FibroScan is a more targeted, non-invasive test that estimates liver stiffness, which can help assess the likelihood of fibrosis. Many FibroScan devices can also estimate the amount of liver fat.
In simple terms, an ultrasound may identify fatty liver, while FibroScan can provide additional information about liver fat and fibrosis risk when further assessment is needed.
Your GP or specialist may also calculate a blood-based risk score such as FIB-4. This uses age and routinely available blood-test results to estimate the likelihood of advanced fibrosis and help determine whether further assessment or referral may be appropriate. It is a screening tool rather than a diagnosis.
More specialised investigations, including MRI-based liver imaging or liver biopsy, are generally reserved for selected circumstances rather than used as routine first-line tests.
The Positive Note: Fatty Liver Can Often Improve
A fatty liver diagnosis can feel worrying, but it can also provide an early signal that your metabolic health may need more support. In many people, liver fat responds well to improvements in diet, movement, sleep and insulin sensitivity, along with reducing or avoiding alcohol.
Earlier-stage MASLD is often highly modifiable. Even MASH, the more inflammatory form, may improve with appropriate medical care and targeted lifestyle support.
Depending on the individual, supporting liver and metabolic health may include:
improving overall dietary pattern quality
increasing fibre intake and plant-food diversity
supporting healthy blood glucose and triglyceride levels
building or maintaining muscle mass
reducing sedentary time
reducing or avoiding alcohol
improving sleep quality and quantity
addressing weight or waist circumference where appropriate
These changes can have benefits extending well beyond the liver, including supporting cardiovascular health, energy, inflammation and long-term wellbeing.
Fatty liver is common, and there is often a great deal that can be done to support improvement. Identifying it provides an opportunity to make sustainable changes that benefit both liver health and overall metabolic health.
Coming Next in Part 2…..
In Part 2 of the Love Your Liver series, we will explore the dietary patterns most consistently associated with better liver and metabolic health. We will also look at how the liver’s natural Phase I, Phase II and Phase III biotransformation and elimination pathways work, the nutrients that support these processes, and the essential role other body systems play, including your gut.
Ready to Take the Next Step?
If you’re unsure what your results mean or where to begin, a naturopathic consultation with Amy can help you understand the bigger picture and develop a realistic, personalised plan to support your liver and metabolic health.
References
Pecani, M., et al. (2025). Metabolic syndrome and liver disease: Re-appraisal of screening, diagnosis, and treatment through the paradigm shift from NAFLD to MASLD. Journal of Clinical Medicine, 14(8), 2750.
Cusi, K., et al. (2025). Metabolic dysfunction–associated steatotic liver disease (MASLD) in people with diabetes: The need for screening and early intervention. Diabetes Care, 48(7), 1057–1082.
Chan, W. K., & George, J. (2024). Metabolic fatty liver syndromes: Where do we stand in 2024? Journal of Gastroenterology and Hepatology, 39, 613–614.
Dong, J., et al. (2025). The impact of estrogen deficiency on liver metabolism: Implications for hormone replacement therapy. Endocrine Reviews, 46, 790–809.
Pekarska, K., et al. (2026). Nutrition in MASLD: A patient focused, evidence-based clinician’s guide. Frontline Gastroenterology, 17, 262–281.
Cano-Contreras, A. D., & Francisco, M. R. (2026). Personalized dietary management in metabolic-associated steatotic liver disease.