Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called nonalcoholic fatty liver disease (NAFLD), is a common liver disease that affects people who drink little or no alcohol. MASLD develops when fat builds up in the liver because of common conditions such as obesity, type 2 diabetes, high cholesterol and high blood pressure.

Because these metabolic conditions are at the root of the disease, metabolic dysfunction-associated steatotic liver disease (MASLD) is now being used more often than nonalcoholic fatty liver disease (NAFLD).

MASLD is more than just fat in the liver. It can progress to a more serious form of liver disease called metabolic dysfunction-associated steatohepatitis (MASH), which was formerly called nonalcoholic steatohepatitis (NASH). Over time, MASH can lead to complications such as heart disease, kidney conditions, liver scarring, also called fibrosis, or even liver failure and the need for a liver transplant.

Two medicines have been approved by the Food and Drug Administration for this condition and may be prescribed depending on liver disease severity. Lifestyle changes remain the main way to prevent, manage and sometimes reverse MASLD.

How to manage MASLD at home

Some ways to boost liver health and manage the symptoms of fatty liver disease include:

Losing weight. For most people, weight loss is the main treatment for MASLD. For people with obesity or those who are overweight, weight loss has been shown to improve MASLD and its symptoms, as well as overall quality of life.

Research shows that losing 7% to 10% of total body weight can reduce liver inflammation and improve liver scarring. But even losing just 5% of your body weight can reduce total liver fat and improve MASLD. If you're not overweight, losing up to 3% of body weight can still help improve liver health.

To manage MASLD with weight loss, you can cut the number of calories you eat each day by 500 to 1,000 calories and increase your physical activity. Aim for 1 to 2 pounds (0.5 to 1.0 kilogram) of weight loss each week through diet and exercise.

Talk with your healthcare team about your weight-loss plan. If you have trouble losing weight, they may recommend medicines, weight-loss surgery or other treatments.

Adopting a Mediterranean diet. Researchers recommend a plant-based diet heavy in fruits, vegetables and whole grains for people with MASLD. Specifically, the Mediterranean diet has been shown to help with weight loss — and to reduce liver fat and improve inflammation — in people with MASLD.

The Mediterranean diet is rich in fruits, vegetables, whole grains, lean proteins such as fish, healthy fats such as olive oil and nuts. It's high in fiber, vitamins, minerals and polyphenols, which are plant compounds that contain antioxidants and anti-inflammatory properties.

Just as important as what the Mediterranean diet contains is what it doesn't contain — and that's food that can lead to MASLD or make it worse. This includes highly processed foods and those high in sugar, saturated fat and refined carbohydrates such as potato chips, baked goods, white bread, red and processed meats, sodas, and sugary cereals.

Changing the way you eat can take time. Talk with your healthcare team about creating a healthy diet plan. Care team members may connect you with a dietitian who can help with meal planning and daily nutrient and calorie goals.

Being more active. Regular physical activity is an essential and safe part of managing MASLD. Exercise can help you manage your weight and help reduce liver fat and prevent liver scarring even before you lose weight. And it can help manage conditions associated with MASLD, such as high blood pressure, high cholesterol, type 2 diabetes and obesity.

For best results, aim for at least 150 minutes of moderate-intensity physical activity a week. If that seems like a lot, think of it this way: That's five days a week for 30 minutes each day.

You don't need to go to the gym. Any movement counts. Walking in your neighborhood, swimming at the local pool, gardening in your backyard, or playing a game with your children or grandchildren counts.

Strength training to improve muscle strength is another good way to be active. This could mean lifting hand weights while watching TV or following along with a strength training video as part of your daily routine.

If you don't already exercise, get your healthcare team's approval and begin gradually. Ask your care team how to safely increase the intensity of your activity as your body gets used to exercise. They can also help you find the exercises that work best for you.

Not drinking alcohol. Even low levels of alcohol can increase the risk of serious liver problems and liver cancer in people with MASLD. Alcohol also can make other health conditions associated with MASLD — such as diabetes and heart disease — worse.

For these reasons, avoiding alcohol is important for managing MASLD.

Not drinking alcohol is especially important for people who've had weight-loss surgery, such as gastric bypass or gastric sleeve. After surgery, stomach space is limited. Alcohol is absorbed more quickly into the bloodstream, so even small amounts of alcohol affect the body and liver much more.

If you need help to stop drinking, talk to your healthcare team. They can offer advice and recommend programs to help you quit.

Getting your sleep in order. Research shows a connection between sleep quality and MASLD. Sleep disorders, such as insomnia and obstructive sleep apnea (OSA), poor sleep quality, and getting too little or too much sleep may increase the risk of MASLD. MASLD also is a risk factor for OSA.

It's important to talk to your healthcare team about your sleep habits and any problems you're having with sleep. They may recommend a sleep study to better understand your sleep problems.

On your own, adopting good sleep habits can help you get the recommended 7 to 9 hours of restful sleep each night. These habits can help:

• Stick to a sleep schedule. Try to go to sleep and wake up at the same times each day. Being consistent helps your body develop a routine.
• Follow the 20-minute rule. If you don't fall asleep within about 20 minutes of going to bed, leave your bedroom and do something relaxing. For example, you might read or listen to calming music. Go back to bed when you're tired.
• Set your bedroom up for success. Keep it cool, dark and quiet. Put room darkening shades on windows. You can wear earplugs or use a fan to drown out any noises that keep you awake.
• Put away the screens. The light from the glowing screens of phones, tablets and televisions can make it difficult to fall asleep. Turn these devices off 30 minutes to one hour before bedtime.
• Don't take long daytime naps. They can interfere with nighttime sleep. Limit naps to no more than an hour, and don't take them late in the day.
• Be active during the day. Get outside if you can. Regular physical activity during the day can mean better sleep at night.
• Avoid nicotine and caffeine. Both chemicals can keep you awake. In fact, caffeine can take 6 to 8 hours to wear off completely. While alcohol may make you tired at first, it can prevent deep sleep.
• Manage your stress. Stress is famous for keeping people awake at night. Take steps to manage nighttime anxiety. One method is writing down your worries before you go to bed at night to help take them off your mind. Gentle yoga or meditation practices before bed also can be helpful.

If you're having trouble with sleep, consider keeping a sleep diary to share with your healthcare team. In it, track your sleep for several weeks. Answer questions such as: What time did you fall asleep? What did you do before you went to bed? How often did you wake up at night and for how long? What time did you get up in the morning?

If your healthcare team finds you have a sleep disorder, you'll be given treatment options. These may include therapy, medicines or mouth guards. For obstructive sleep apnea, treatment may include a CPAP machine that helps keep the airway open so that you can breathe at night.

Quit smoking. Research has shown a link between smoking and liver damage, increased liver scarring, and MASLD in general. Smoking also raises the risk of liver cancer. The more you smoke, the higher the risk of damage to your liver.

If you smoke, take steps to stop. Quitting can help improve your treatment outcomes and liver scarring and reduce your risk of liver cancer.

Stopping smoking is hard, but help is available. Ask your healthcare team about programs and treatments that can help. These may include nicotine replacement products, treatment programs or other supports.

Manage diabetes. Type 2 diabetes is a significant risk factor for MASLD. People with MASLD have a greater risk of developing type 2 diabetes.

People with type 2 diabetes are also more likely to develop a more serious form of MASLD, called metabolic-associated steatohepatitis (MASH), which includes greater liver inflammation and damage. MASH was formerly known as NASH.

If you have diabetes, take the medicines prescribed by your care team and closely monitor your blood sugar. If you haven't been diagnosed with diabetes, get regular screenings.

Lower your cholesterol and blood pressure. People with MASLD are at increased risk of high blood pressure, also called hypertension, and heart disease. High blood pressure increases the risk of developing MASH — especially when combined with other conditions such as diabetes or high cholesterol. High blood pressure can increase liver scarring.

Eating a healthy, plant-based diet and getting regular exercise are good first steps. Take any medicines prescribed by your healthcare professional to help keep cholesterol and blood pressure at healthy levels.

Medicines called statins are often used to lower cholesterol and reduce the risk of heart disease. Research shows that statins can be used safely in people with MASLD. If you need a statin, your healthcare professional will choose the type and dose for you and monitor your liver function while you're taking it.

Manage stress. Some research points to a connection between MASLD and stress. Chronic stress can increase inflammation in the body and may even worsen MASLD. And having MASLD can increase stress.

Here are some things you can do to help prevent and control the stressors in your life:

• Practice gratitude. Make it a habit to notice the good things in your life. One way to do this is to keep a gratitude journal, writing down the things you're thankful for.
• Get less screen time. Spend less time in front of laptops, tablets or televisions and more time relaxing without electronics. Read a book, take a walk, learn a new hobby, or do a puzzle.
• Slow your schedule. Say no to activities and events that cause you stress or overfill your calendar. Set aside time to do the things you truly enjoy or that bring you peace.
• Try mindfulness practices. These are activities that help you quiet your mind and live in the moment. Consider yoga, meditation, deep-breathing exercises or spending time in nature.
• Lean on loved ones. Create a support network of friends and family who can help when you're feeling stressed.
• Talk to your healthcare team. If stress is taking over your life, tell your healthcare team. They may recommend talk therapy or other treatments to help manage your stress.

Review your medicines and supplements. Only take the medicines you need and that have been recommended by your healthcare team. Tell your care team about all supplements you take, even if you think they're safe. And make sure you closely follow the dosing guidelines.

Though it can be tempting to try a supplement that promises to clean or "detox" the liver, this type of supplement usually isn't a good idea. Some supplements that claim to help the liver can actually harm it. Others that are generally safe, such as milk thistle, may not have been proved effective for improving liver health.

Get vaccinated. Make sure you're up to date on your hepatitis A and hepatitis B vaccinations. Liver inflammation, also known as hepatitis, can increase the risk of liver failure in people with MASLD.

Also check your medical record or ask your healthcare professional about any other vaccinations you may need, such as the pneumococcal vaccine or annual flu shot.

Alternative medicines for MASLD

No alternative medicine treatments have been proved to cure MASLD. But researchers are studying whether some supplements or natural compounds might be helpful. These include:

Coffee. Some studies suggest that black caffeinated coffee may help the liver by reducing the risk of liver diseases such as MASLD and by lowering the chance of scarring. It's not yet clear exactly how coffee may prevent liver damage, but certain compounds in coffee are thought to lower inflammation and slow scar tissue growth.

That doesn't mean you should add a few high-sugar mocha lattes to your day. In fact, the extra sugar and fat in these drinks should be avoided by people who have MASLD. But if you enjoy a couple of cups of black coffee in the morning, feel good about continuing that routine.

Omega-3 fatty acids. Some studies have suggested that omega-3 fatty acids may improve liver fat in people with MASLD, but more research is needed.

Certain vitamins. For instance, vitamin E may have a role in improving liver fat and inflammation in MASLD. However, more information is needed to confirm these findings.

Talk to your healthcare team before taking any vitamins or supplements for MASLD.

Tips for making MASLD lifestyle changes

Making lifestyle changes can be hard. But even small positive changes can make a difference to your health. Here are some tips to help you make the changes necessary to successfully manage MASLD:

• See your healthcare team regularly. Care team members can help shape your self-care program and work with you to track your progress. They also can connect you with helpful resources, such as appointments with a dietitian or behavioral therapist.
• Seek out support groups. You can find MASLD support groups online, at your healthcare institution or through organizations such as the American Liver Foundation.
• Use technology. Download mobile apps that help track your weight, activity and goals. These tools can help you lose weight, eat a healthier diet and improve liver health.
• Set manageable goals. Work with your healthcare team to set lifestyle goals you can achieve. For instance, you might set a goal to take a walk at least five days a week. Make sure to celebrate your successes and increase your goals as time goes on.

Learn more about MASLD and clinical trials at Mayo Clinic.

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Oct. 09, 2025 See more In-depth