Is your liver holding onto too many fats? Discover why doctors renamed fatty liver disease and what it means for your health.

Have your doctor ever told you that you have extra fat in your liver? You might wonder what that means or if you should worry. Do not panic. Today, we are talking all about fatty liver disease. Medical experts now call this condition Steatotic Liver Disease (SLD). In the past, people just called it a fatty liver. What does this really mean? Why did doctors change the name? Let us break down everything in a simple way.

Why Did the Name Change From Fatty Liver?

In the past, everyone called this condition fatty liver disease. In the year 2023, medical experts decided to update the name. They chose to use the term Steatotic Liver Disease (SLD). There are two main reasons for this change. First, the new name explains the exact causes of the disease much better. For instance, while carrying extra body weight or having obesity is a major factor, other risk factors have nothing to do with body weight at all.

Second, the old phrase sometimes made people feel embarrassed or blamed. Changing the term helps remove that negative feeling. To keep things simple, steatosis is the medical word doctors use to describe fat building up inside an organ, usually the liver. A healthy liver that works well has a small amount of fat. This fat buildup only becomes a problem when it goes above five percent of your total liver weight.

What Are the Types of Steatotic Liver Disease?

Doctors divide SLD into different categories based on what causes the fat buildup and what other health conditions you might have. Let us look at the main types in detail.

1. Alcohol-Related Liver Disease (ALD).

This type happens when the amount of alcohol you drink is too high for your liver to process safely. When you drink alcohol, your liver works hard to filter and clean it out of your body. During this cleaning process, some liver cells get damaged. A healthy liver can usually make new cells to replace the damaged ones. However, if you keep drinking heavy amounts of alcohol over a long time, your liver cannot keep up with the repair work.

That is when fat starts to build up inside the liver. This early stage is known as steatosis. Cutting out alcohol gives your liver a chance to rest and heal.

2. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).

In the past, doctors called this non-alcoholic fatty liver disease (NAFLD). That is because extra alcohol use does not cause the fat buildup in this case. The new name highlights that the main triggers are cardiometabolic risk factors. Simply put, certain health conditions and traits that affect your heart and blood vessels are the root cause.

The main risk factors that can lead to MASLD include:

• Carrying too much body weight or having obesity.
• Having type 2 diabetes.
• Having high blood pressure.
• Having abnormal levels of fats in your blood, such as high cholesterol or high triglycerides.

Even if you drink a small amount of alcohol each week, you may still fall into the MASLD category. For women, this means less than 140 grams of alcohol per week. For men, it means less than 210 grams per week. As a quick example, a standard twelve-ounce can of beer contains about fourteen grams of alcohol.

3. Metabolic-Associated Steatohepatitis (MASH).

MASH is a more serious form of MASLD. In this condition, the extra fat stored in your liver causes the organ to swell and become inflamed. Over time, this ongoing inflammation damages your liver tissue. This damage leads to the formation of scar tissue, which doctors call fibrosis. In the past, doctors called this non-alcoholic steatohepatitis (NASH).

4. MASLD and Increased Alcohol Use (MetALD).

If you have MetALD, it means both metabolic risk factors and alcohol use are contributing to your liver fat buildup. In this situation, you have cardiometabolic risk factors while also drinking more alcohol than the low limits. For women, this is more than 140 grams per week. For men, it is more than 210 grams per week.

The extent to which alcohol or metabolic risk factors contribute to your liver fat can vary greatly from one person to another.

5. Other Types of SLD.

SLD can also develop without any heavy alcohol use or metabolic risk factors. For example, certain medicines and other rare medical conditions can cause fat to build up in the liver. Sometimes, doctors cannot find a clear reason for the condition. When there is no clear cause, they call it cryptogenic SLD.

✨ Clinical nutrition Verified Partner

Clinical vitamins and nutritional supplements

Clinically proven high quality vitamins, minerals and immune nutritional supplements.

Check Availability →

Is Steatotic Liver Disease a Serious Problem?

In most cases, extra fat in the liver does not cause major problems or stop your liver from doing its normal job. However, this condition can sometimes slowly get worse and turn into a severe liver disease. This progression usually happens in a few clear stages:

• Liver Inflammation (Hepatitis): First, the fatty liver swells up and gets inflamed. This inflammation hurts the liver cells. This stage is known as steatohepatitis. For instance, this is how MASLD turns into MASH over time.
• Liver Fibrosis (Scarring): Because of ongoing inflammation, scar tissue forms where the liver has damage. This makes the liver tissue stiffer. Doctors call this process fibrosis.
• Liver Cirrhosis: In this advanced stage, healthy liver tissue is largely replaced by permanent scar tissue. This condition is known as cirrhosis of the liver. Without proper medical care, cirrhosis can lead to dangerous conditions like liver failure and liver cancer. For example, about 90 percent of people who develop hepatocellular carcinoma (a common type of liver cancer) already have cirrhosis.

What Are the Symptoms of SLD?

Not everyone with SLD has obvious symptoms. When people do notice symptoms, they might include:

• A dull ache or a feeling of fullness in the upper right side of your belly.
• Feeling very tired or weak all the time.

However, many people do not notice any warning signs until SLD progresses into cirrhosis. Once cirrhosis develops, you might notice symptoms such as:

• Feeling sick to your stomach or nauseous.
• Loss of appetite.
• Losing weight without trying.
• Your skin and the whites of your eyes turning a yellow color, which doctors call jaundice.
• Your belly swelling up due to fluid buildup, known as ascites.
• Your legs, arms, or ankles swelling up, known as edema.
• Bleeding easily, which your doctor might spot in your food pipe, stomach, or lower gut.

What Causes Steatotic Liver Disease?

Several factors can cause SLD. You have a much higher chance of developing SLD if you have a cardiometabolic risk factor, if you use alcohol in ways that harm your health, or if you have both.

Your risk goes up if you have any of the following conditions:

• Alcohol use disorder, meaning you drink alcohol often or in heavy amounts.
• Metabolic syndrome, which includes insulin resistance, high blood pressure, high cholesterol, and high triglycerides.
• Type 2 diabetes.
• Being overweight, meaning your body mass index (BMI) is between 25 and 29.9.
• Having obesity, meaning your BMI is 30 or higher.
• Polycystic ovary syndrome (PCOS).
• Obstructive sleep apnea, where you stop breathing for short periods while sleeping.
• Hypothyroidism, meaning your thyroid gland is underactive.
• Hypopituitarism, meaning your pituitary gland makes too few hormones.
• Hypogonadism, meaning your body makes low levels of sex hormones.
• Taking certain medicines long-term, such as amiodarone, diltiazem, tamoxifen, or steroids. Sometimes, these medicines can cause fat buildup as a side effect.

What Are the Complications of SLD?

If you leave a fatty liver untreated, it can turn into cirrhosis. Cirrhosis can cause liver failure, liver cancer, and other types of cancer outside the liver. People with MASLD also have a higher chance of developing heart disease. In fact, heart disease is often the main cause of death for people with MASLD, rather than liver disease.

How Do Doctors Diagnose SLD?

Because SLD often has no early symptoms, your doctor might be the first to spot it. For instance, routine blood tests done for another reason might show high levels of liver enzymes. High liver enzymes mean your liver is having some irritation or damage.

To confirm a diagnosis, your doctor may use several methods:

• Reviewing your medical history: They will ask about your overall health, how much alcohol you drink, and what medicines you take.
• Doing a physical exam: They will check if your liver feels enlarged or look for signs of cirrhosis like jaundice.
• Imaging tests: An ultrasound, CT scan, or MRI scan helps your doctor check your liver for inflammation and scarring. Doctors can also use a special ultrasound test called a FibroScan to measure the amount of fat and scar tissue in your liver.
• Liver biopsy: In this test, a doctor takes a tiny sample of your liver tissue to check it under a microscope. A liver biopsy is currently the only way to tell the exact difference between MASLD and MASH.

How Do Doctors Treat SLD?

There is no single magic pill or specific medicine designed to cure SLD. Instead, doctors focus on helping you control the risk factors that cause the disease. This approach includes making healthy changes to your daily lifestyle.

Your doctor may recommend the following steps:

• Stop drinking alcohol completely: Even if alcohol did not cause your SLD, staying away from alcohol gives your liver the best chance to heal.
• Lose extra weight: Eating healthy food, exercising regularly, and working with a nutritionist can help. In some cases, doctors might suggest weight loss medicines like GLP-1 receptor agonists. For people with severe obesity, weight-loss surgery might be an option.
• Manage metabolic health conditions: Take your prescribed medicines on time to control diabetes, high cholesterol, and high triglycerides. In special cases, doctors may recommend vitamin E or medicines like thiazolidinediones to help manage inflammation.
• Get vaccinated: Get shots for hepatitis A and hepatitis B. These viral infections are especially dangerous if you already have a liver condition.

If a specific medicine you take causes fat to build up in your liver, your doctor may safely adjust your prescription.

How Can You Prevent SLD?

The best way to prevent SLD is to keep your whole body healthy:

• Exercise on a regular basis.
• Limit your alcohol intake or avoid it completely.
• Keep a healthy body weight.
• Take your prescribed medicines if you have type 2 diabetes or metabolic syndrome.

Can You Heal From SLD?

Depending on how serious your condition is, you can often reverse SLD and even heal some liver scarring. Your liver has an amazing ability to repair itself. If you follow your doctor plan closely, you can reduce fat and inflammation in your liver. This helps stop further damage and can sometimes reverse early liver injury.

Can SLD Lead to Death?

For most people, SLD does not cause severe problems unless it progresses into advanced cirrhosis. Many people with SLD live a normal, healthy lifespan.

However, untreated cirrhosis can eventually lead to liver failure or liver cancer. Your liver is an organ you cannot live without. That is why finding out you have SLD is so important for protecting your health.

What Is a Good Diet for Someone With SLD?

If your SLD is linked to extra body weight, follow a balanced meal plan to lose weight slowly and steadily. Doctors often advise cutting out sugary foods and drinks. They also recommend trying the Mediterranean diet. This eating style includes plenty of fresh vegetables, fruits, and healthy fats.

Nuts, leafy greens, whole grains, fish, and chicken are also great food choices if you have SLD. Try to limit red meat and sugary drinks.