MASLD and MASH: Understanding “Fatty Liver’s” New Name and How Lifestyle Can Help
Written by: Lisa Spriet, RD
Updated: December 17th, 2025
Fatty liver disease is becoming increasingly common around the world, including in Canada. It is now one of the most prevalent liver conditions. What was once known as non-alcoholic fatty liver disease (NAFLD) now has new terminology:
- Metabolic dysfunction–associated steatotic liver disease (MASLD), which can progress to:
- Metabolic dysfunction–associated steatohepatitis (MASH)
These names highlight the underlying metabolic causes of fatty liver, such as insulin resistance, obesity, high blood pressure, and abnormal cholesterol (Tilg et al., 2025; Cusi et al., 2025).
Evidence shows that up to 25% of Canadian adults may have MASLD, making it one of the leading contributors to liver-related illness and liver transplant needs (Liver Foundation, 2025).
What are MASLD and MASH?
MASLD: “Metabolic” Fatty Liver
MASLD occurs when excess fat accumulates in the liver along with at least one metabolic risk factor. These include overweight/obesity, type 2 diabetes, high blood pressure, and dyslipidemia (Cusi et al., 2025; Tilg et al., 2025). MASLD used to be called Non-Alcoholic Fatty Liver Disease, and the change in nomenclature (name) represents the role that metabolic diseases play in this type of fatty liver disease.
MASH: The More Serious, Inflammatory Stage
MASH is diagnosed when fat buildup leads to:
- Liver inflammation,
- Liver cell injury, and
- Fibrosis (scar tissue)
This stage carries higher risk of cirrhosis, liver failure, and hepatocellular carcinoma (Luthra et al., 2025; Sanyal et al., 2021).
Roughly 20% of people with MASLD progress to MASH, especially if metabolic health is not addressed (Singh et al., 2015).
Who is at Risk for MASLD and MASH?
Most people with MASLD have at least one of the following:
- Overweight or obesity
- Type 2 diabetes or prediabetes
- High triglycerides or low HDL
- High blood pressure
- Features of metabolic syndrome (Cusi et al., 2025)
Having one or more of these conditions increases one’s chances of MASLD. Even people with normal weight (BMI or body mass index) can develop MASLD if they have insulin resistance or a strong family history (Goto et al., 2025).
If not treated, MASLD can progress to MASH, and eventually permanent liver damage.
How Do MASLD and MASH Progress?
Progression involves multiple metabolic and inflammatory pathways:
Insulin Resistance
Excess fat and carbohydrate intake increase insulin resistance, causing more fat deposition in the liver (Mejía-Guzmán et al., 2025).
Lipotoxicity
Some fat types are toxic to liver cells and trigger damage.
Oxidative Stress and Inflammation
Damaged liver cells produce inflammatory signals, perpetuating injury.
Fibrosis (Scarring)
Over time, inflammation leads to scar tissue. People with MASH progress twice as fast as those with simple steatosis, one fibrosis stage every 7 years, compared with 14 years (Singh et al., 2015).
MASLD and MASH are measured by fibrosis staging. Fibrosis stage is the strongest predictor of long-term liver outcomes (Sanyal et al., 2021).
Symptoms: Why MASLD is Called a “Silent Disease”
Many people with MASLD or even early MASH have no symptoms. Possible early symptoms include:
- Fatigue
- Mild abdominal discomfort
- Feeling bloated or unwell (Tilg et al., 2025)
Advanced disease may cause:
- Jaundice
- Swelling of the abdomen or legs
- Easy bruising
- Confusion (Sanyal et al., 2021)
How Are MASLD and MASH Diagnosed? Why is it tricky?
Since MASLD and MASH can be silent, or develop without symptoms, diagnosis can be tricky. Oftentimes people get diagnoses when having imaging for another reason. Additionally, diagnosis often includes several exams to both diagnosis, as well as determine which stage an individual is in. Healthcare providers may use:
Blood Tests
- Liver enzymes such as ALT, AST
- HbA1c and fasting glucose
- Cholesterol and triglycerides
However, liver enzymes may be normal even in advanced disease, so they are not reliable alone (Tilg et al., 2025).
Imaging
- Ultrasound detects moderate fat, but isn’t able to give an accurate score or measure and doesn’t detect initial stages of MASLD
FibroScan® (transient elastography) measures stiffness (fibrosis), and now widely recommended in Canada as it can accurately access liver health and stage of MASLD and MASH (Tacke et al., 2024)
Non-invasive Scores
- FIB-4 is an index that includes age and blood measurements to give an estimate of liver fibrosis or scoring
- NAFLD fibrosis score
Biopsy
Used when diagnosis is uncertain or fibrosis is suspected. As this is more invasive, it isn’t often used to diagnose MASLD or MASH.
Why Early Identification Matters
Early detection gives time to reverse liver fat, reduce inflammation, and stabilize or reverse fibrosis.
Research shows:
- Fibrosis score is the strongest predictor of mortality (Sanyal et al., 2021).
- Lifestyle changes, including weight loss of 7–10%, can significantly improve inflammation and fibrosis (Mejía-Guzmán et al., 2025).
- Most people with MASLD die from cardiovascular disease, not liver disease (Tilg et al., 2025).
This means MASLD is not only a liver issue, it reflects whole-body metabolic health.
The Impact of MASLD and MASH on Health
MASLD and MASH are not just liver conditions, they are markers of poor metabolic health that significantly increase the risk of serious chronic disease.
Heart Disease Is the Biggest Risk
Most people with MASLD do not die from liver failure. Instead, cardiovascular disease (heart attack and stroke) is the leading cause of death in those with MASLD and MASH (Tilg et al., 2025). Liver fat reflects underlying insulin resistance, abnormal cholesterol, inflammation, and high blood pressure, all major drivers of heart disease (Cusi et al., 2025).
Risk of Liver Failure and Liver Cancer
As MASLD progresses to MASH, ongoing inflammation can lead to fibrosis (scarring), cirrhosis, liver failure, and liver cancer. Fibrosis stage is the strongest predictor of long-term survival, regardless of liver enzyme levels (Sanyal et al., 2021).
Strong Link to Type 2 Diabetes
MASLD both contributes to and worsens type 2 diabetes. People with diabetes are at much higher risk of developing MASH and advanced fibrosis, accelerating disease progression if metabolic health is not addressed (Cusi et al., 2025).
Reduced Quality of Life
Even before advanced disease, many people experience fatigue, low energy, and reduced physical capacity. Advanced stages can cause fluid retention, muscle loss, and cognitive symptoms that significantly affect daily life (Sanyal et al., 2021). Additionally, learning that you have liver disease can be very stress inducing.
MASLD is a red flag for whole-body health, signalling increased risk of heart disease, diabetes, and premature death. The encouraging news is that early-stage MASLD and MASH often improve with lifestyle changes, especially nutrition therapy, physical activity, and modest, sustained weight loss.
Nutrition for MASLD and MASH: Evidence-Based Approach
Diet and lifestyle remain the cornerstone of MASLD and MASH treatment. And lucky, there are several dietary approaches that have been shown to be helpful. Mediterranean-style eating pattern is the most researched diet for fatty liver. It includes:
- Vegetables and fruits
- Whole grains (quinoa, brown rice, barley, oats)
- Legumes (beans, lentils)
- Olive oil
- Nuts and seeds
- Fatty fish
- Minimal added sugar and processed foods
This pattern improves insulin resistance and reduces liver fat (Huang et al., 2025).
High-Fibre Foods
Fibre supports blood sugar control and decreases liver fat.
High fibre foods to include are:
- Broccoli, Brussels sprouts, leafy greens
- Oats, barley, quinoa
- Beans, chickpeas, lentils
- Berries, apples, pears (Liver Foundation, 2025)
Healthy Fats
Foods rich in monounsaturated and omega-3 fats reduce inflammation. Include:
- Extra virgin olive oil
- Avocado
- Nuts: walnuts, almonds
- Fatty fish: salmon, trout, sardines (Huang et al., 2025)
Foods to Limit
- Sugary drinks and fruit juice
- White flour products
- Processed meats
- Deep-fried foods
- Excess red meat
- High-sugar desserts
Are There Foods That Can Specifically Help the Liver?
While the most evidence supports dietary patterns, such as the Mediterranean Diet, there are some specific foods that can help.
Coffee
Strong evidence shows:
- Reduced liver inflammation
- Lower fibrosis risk
- Lower liver cancer risk (Tilg et al., 2025)
Aim for 2–3 cups/day (unless contraindicated).
Fatty fish
Omega-3s reduce liver fat and triglycerides. Aim for 3-5 servings per week or consider supplementing.
Cruciferous vegetables
Vegetables such as Brussels sprouts, broccoli and cauliflower support antioxidant and detoxification pathways. Try to include cruciferous veggies daily.
Leafy greens
A high intake of greens such as kale, spinach and collard greens help improve insulin sensitivity and metabolic function. Try to include leafy greens daily.
Berries
Rich in antioxidants; improve glucose tolerance. Fresh or frozen try to include berries such as blueberries, strawberries, and blackberries daily.
Oats & Barley
Whole grains such as oats, barley and rye contain beta-glucan, which lowers cholesterol and liver fat. Include these whole grains daily.
Supplements: What’s True and What’s Not
As the rates of MASLD increase, so does the marketing of supplements aimed to improve liver function. Buyer beware as there is often little research behind these products.
Not Recommended or Lacking Evidence
- Milk thistle
- Turmeric/curcumin supplements (although these can be helpful for other conditions)
- “Liver detox” teas
- Herbal cleanses
- Keto/weight-loss supplements
Many have no proven liver benefit and can be harmful in high doses (Mayo Clinic, 2025).
May Be Helpful in Select Cases (Medical Guidance Required)
- Vitamin E: May help non-diabetic adults with biopsy-proven MASH, but has long-term risks.
- Omega-3: Useful for lowering triglycerides; food sources preferred.
Always discuss supplements with a clinician before starting.
A Sample Liver-Friendly Day of Eating
Breakfast
Spinach & Mushroom Omelette
- 2 eggs + 1 egg white with Sautéed spinach, mushrooms
- Whole grain bread made with oat flour
- ½ cup fresh berries
- Black coffee
Why: High protein, nutrient-dense vegetables, antioxidants.
Snack
Greek Yogurt Parfait
- ¾ cup plain Greek yogurt
- ¼ cup berries
- 1 tbsp ground flaxseed
Lunch
Mediterranean Grain Bowl
- ½ cup quinoa
- ½ cup chickpeas
- Cucumber, tomato, parsley and chopped broccoli
- ¼ avocado
- Lemon + olive oil dressing
Snack
Walnuts + Apple
Dinner
Baked Salmon with Roasted Vegetables
- Salmon fillet
- Brussels sprouts, carrots, cauliflower
- Olive oil + lemon
- ½ cup barley or brown rice
Key Takeaways
- MASLD and MASH are extremely common, often silent, and strongly tied to metabolic health.
- Early diagnosis allows for lifestyle intervention that can reverse liver fat and reduce fibrosis risk.
Nutrition—especially a Mediterranean dietary pattern—is foundational to treatment. - Supplements rarely offer meaningful benefit and should be used cautiously.
Working with a registered dietitian can make dietary changes easier, more personalized, and more sustainable.
References
Cusi, K., Anstee, Q. M., Beaton, M. D., et al. (2025). Metabolic dysfunction–associated steatotic liver disease (MASLD) in people with diabetes: The need for screening and early intervention. Diabetes Care.
Goto, H., Okamoto, M., & Takahashi, Y. (2025). Metabolic dysfunction–associated steatotic liver disease: A liver manifestation of diabetes. Journal of Diabetes Investigation.
Huang, D. Q., Nguyen, M. H., Lee, J., et al. (2025). Metabolic dysfunction–associated steatotic liver disease: Global burden, natural history, and treatment strategies. Hepatology.
Liver Foundation. (2025). Fatty liver disease: Causes, symptoms, and treatment. liver.ca.
Luthra, R., Rao, S., & Banerjee, R. (2025). Understanding MASH: An examination of progression and mortality risk. Advances in Therapy, 42, 1–15.
Mayo Clinic. (2025). Vitamins and supplements for fatty liver disease (MASLD).
Mejía-Guzmán, J. E., et al. (2025). Metabolic dysfunction-associated steatotic liver disease. International Journal of Molecular Sciences, 26(7), 2959.
Sanyal, A. J., Harrison, S. A., Bass, N. M., et al. (2021). Prospective study of outcomes in adults with nonalcoholic fatty liver disease. New England Journal of Medicine, 385, 1559–1569.
Singh, S., Allen, A. M., Wang, Z., Prokop, L. J., Murad, M. H., & Loomba, R. (2015). Fibrosis progression in nonalcoholic fatty liver vs. nonalcoholic steatohepatitis: A meta-analysis. Clinical Gastroenterology and Hepatology, 13(4).
Tacke, F., Vonghia, L., Castera, L., et al. (2024). EASL–EASD–EASO clinical practice guidelines on the management of metabolic dysfunction–associated steatotic liver disease (MASLD). Journal of Hepatology.
Tilg, H., Petta, S., Stefan, N., & Targher, G. (2025). Metabolic dysfunction–associated steatotic liver disease in adults: A review. JAMA.
