The new names
What used to be called NAFLD is now called MASLD (metabolic dysfunction-associated steatotic liver disease). Its inflammatory form, previously NASH, is now MASH. The new names reflect the cause: the same metabolic problems that drive diabetes and heart disease.
How it progresses
- Fat in the liver (steatosis): common, and often reversible.
- Inflammation (MASH): liver cells are damaged.
- Fibrosis: scarring builds up. This is the stage that predicts long-term risk.
- Cirrhosis: severe scarring, with a risk of liver failure and liver cancer.
Who is at risk
- Excess weight, especially around the waist
- Type 2 diabetes or prediabetes
- High triglycerides or low HDL cholesterol
- PCOS and sleep apnoea
- HIV, and some HIV medicines
Treatment
- Weight loss is the core treatment. Losing 5% reduces liver fat; 7–10% can reduce inflammation and sometimes scarring.
- Cutting alcohol and sugary drinks, especially fructose-sweetened ones.
- Semaglutide: in August 2025 the US FDA granted accelerated approval to semaglutide 2.4 mg (Wegovy) for adults with MASH and moderate to advanced fibrosis. In the ESSENCE trial, 63% had their MASH resolve, compared with 34% on placebo.
- Tesamorelin reduced liver fat in a trial of people with HIV. It is not approved for fatty liver.
Testing
Liver blood tests, an ultrasound and a simple scarring score (FIB-4, calculated from routine bloods) are the usual first steps. Elastography (FibroScan) gives a more accurate picture of scarring.
Talk it through with a doctor
Whether any of these medicines is right for you depends on your health, your history and your goals. The first phone consultation is free, and there is no obligation.
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