What are the stages of MASLD?
There are several stages of MASLD (also called NAFLD). Having one stage does not mean you will definitely develop the next one. Treating MASLD with a healthy diet, physical activity and weight loss can slow or even reverse liver damage, especially if it is at an earlier stage.
The amount of scarring (fibrosis) in your liver is the main sign of how advanced your MASLD is. Jump to information on tests for scarring.
- Fatty liver (fibrosis stage 0): There is a build-up of fat in your liver but it has not been damaged and there is no scarring. This can be fully reversed.
- MASH or NASH with mild fibrosis (fibrosis stage 0 or 1): There is no or very little scarring. Healthy living can undo the damage and reverse your MASLD.
- MASH or NASH with moderate fibrosis (fibrosis stage 2): Inflammation and damage have caused some scarring. Your liver is probably still working well and the damage can mostly be repaired.
- MASH or NASH with advanced fibrosis (fibrosis stage 3): There is a lot of scarring. At this stage it is very important to stop further damage and scarring so things don’t get worse. And it is still possible to repair some damage.
- Cirrhosis (fibrosis stage 4): There is so much scarring it changes the shape of your liver. Your liver can keep working and even repair some damage at this point. But if too much of it becomes scarred, your liver may not be able to carry out its job properly.
Cirrhosis can lead to life-threatening conditions including liver cancer and liver failure.
Causes and Symptoms
What causes MASLD?
MASLD, also known as NAFLD, is estimated to affect up to 1 in 5 people in the UK. Rates are increasing with rising levels of obesity. Although most cases of MASLD are linked to excess weight, you can develop the disease if you have a healthy weight.
These things increase the risk of MASLD:
- A weight in the overweight or obese range
- A high waist measurement
- Type 2 diabetes
- A diet with too many unhealthy foods and drinks
- Low levels of physical activity or spending a lot of time sitting down
- High blood lipids such as cholesterol
- High blood pressure
- Other conditions linked to insulin resistance for example polycystic ovary syndrome
Check if you are at risk of liver disease
Fatty liver is a stage in many types of liver disease. In these diseases it is caused by other things, for example alcohol or side effects from a medicine. Your doctor will check if these things could play a role. Read more about the fatty liver stage of liver disease.
Related conditions
Fatty liver disease is one of a cluster of conditions that are linked to how the body produces, uses and stores energy from food (metabolism). This includes heart and circulatory diseases, type 2 diabetes, and other conditions linked to insulin resistance.
These conditions often develop together and the same person can have several of them. If you are diagnosed with fatty liver disease or any other metabolic condition talk to your GP. They can monitor your risk of developing a related condition and help you to reduce it.
What are the symptoms of MASLD?
There are often no specific symptoms, even if the disease is at a later stage. You may not show any symptoms for many years. If you have MASLD or NAFLD you may have:
- Tiredness, fatigue or a general feeling of lethargy or having no energy
- Discomfort on the upper right side of your tummy (where your liver is)
If you develop any of the following symptoms tell a doctor straight away:
- yellowness of the eyes and skin (jaundice) – this may be harder to notice if you have black or brown skin
- bruising easily
- dark urine
- swelling of the tummy area (ascites)
- vomiting blood
- dark black tarry poo
- periods of confusion, forgetting things, mood changes or poor judgement (encephalopathy)
- itching skin
Even if you have no symptoms if you are at risk and are worried ask your doctor for a test.
Patient Stories
Click on an image to read their story, or share your own to help us raise awareness of fatty liver disease.
Rebecca’s story: “I’ve lost weight and my outlook on life is so much better”
Cheryl’s story “I received my NAFLD diagnosis in a letter and was left to my own devices. I was anxious that I might die and kept thinking I’ve got a little girl to look after”
Chris and Sam’s story: “We weren’t told about encephalopathy at all”
Paul’s story: “You talk to people about liver disease and they say: ‘Shut up, you could be hit by a bus tomorrow'”
How is MASLD diagnosed?
MASLD and NAFLD might only be diagnosed when they have become serious. Or you might be diagnosed after having tests for another health problem.
If your doctor thinks you have any form of liver disease they will try to find out what is causing it and how damaged your liver is. Doctors use a range of tests to get different information and build up an overall picture of what is happening. This often includes:
- Blood tests, especially for alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
- Ultrasound or transient elastography such as FibroScan
- Biopsy
As part of diagnosing MASLD, your doctor needs to rule out other causes of liver disease. They will ask you about:
- the amount of alcohol you drink
- any other medical conditions
- any medicines you take including ones your doctor has prescribed and over-the-counter medicines you buy for things like pain relief, coughs and colds, or stomach upsets
- homeopathic or alternative supplements or remedies
- recreational drugs
- your diet and the foods you usually eat
- how physically active you are
It is important to give your doctor as much information as you can. This will help them to diagnose your condition correctly and give you the right care.
The different names for fatty liver disease
In 2023 an international group of doctors, scientists and patients announced that NAFLD would change its name to MASLD. These are both medical names for fatty liver disease.
It will take time for everyone to start using the new names, so for now you will probably hear and read a mix of names. Knowing the different names can help make conversations clearer – but you can use whatever name you’re most comfortable with. In our information, we use all the names to help everyone find what they need. Use the form at the bottom of the page to let us know how we’re doing.
The new name MASLD stands for metabolic dysfunction-associated steatotic liver disease. Some of these words are only really used by doctors and scientists, so lots of people don’t know what they all mean.
- Metabolic means connected with how your body uses and stores energy from food. Other metabolic diseases include type 2 diabetes and heart disease. They are all linked to things like weight, diet, physical activity, and blood pressure.
- Dysfunction means that something isn’t working properly or has gone wrong.
- Associated means linked to or caused by.
- Steatotic means fatty.
So all together the name MASLD means fatty liver disease caused by something going wrong with how your body uses and stores energy. For example, gaining weight leading to your body storing too much fat in your liver.
The more serious form of MASLD is called MASH – metabolic dysfunction-associated steatohepatitis. The hepatitis part means inflammation in your liver.
The old name NAFLD stands for non-alcohol related fatty liver disease. The more serious form is NASH or non-alcohol related steatohepatitis.
Fatty liver is an early stage in many different types of liver disease. Inflammation, or hepatitis, is the next stage after fatty liver. Read more about the stages of liver disease.
Fibrosis (scarring) tests and scores
It is very important that the amount of scarring in your liver is tested as part of your MASLD or NAFLD diagnosis. This is the main sign of how advanced your liver disease is.
Fibrosis is the medical term for scarring. It is measured on a scale of 0 to 4. The higher the number, the more fibrosis there is and the more severe it is.
There are 2 main ways to check if you’re likely to have advanced fibrosis (stage 3 or 4) without doing a biopsy – blood tests or a liver scan (transient elastography eg FibroScan).
Many doctors use a scoring system that pools results from several routine blood tests. Common fibrosis scoring systems include:
- The Fibrosis (FIB)-4 score which uses 3 blood tests and your age
- The NAFLD Fibrosis Score which uses 4 blood tests and information about your age, weight (BMI) and whether you have diabetes
- The Enhanced Liver Fibrosis (ELF) test which uses a combination of 3 blood tests.
The score doesn’t say exactly how much scarring there is in your liver. Your doctor or nurse will interpret the result to decide what to do.
There are 3 possible results:
A low risk means advanced fibrosis can be safely ruled out.
This means you don’t have later stage MASLD including cirrhosis. Your GP will continue to manage your care. They should do a fibrosis test every 3 years to check your condition hasn’t got worse.
Indeterminate risk means it doesn’t say for sure whether you have advanced fibrosis or not.
You should be offered further tests to find out. These could include scans or a liver biopsy.
A high risk means that you probably have advanced fibrosis.
It’s likely you have later stage MASLD and you may have cirrhosis. You will be referred to a specialist liver doctor (hepatologist or gastroenterologist) who will do further tests and manage your care from then on.
Who will manage my care?
GPs manage care for earlier stage fatty liver disease (primary care)
This can include fatty liver and MASH or NASH with mild or moderate fibrosis.
Your liver has little or no long-term damage or scarring and is probably still working well. By eating healthily, doing plenty of physical activity and keeping your weight in a healthy range you have a good chance of repairing any damage and reversing your fatty liver disease.
Your doctor or nurse will have a conversation with you about your weight, the foods you eat, and how physically active you are. They’ll give you information and help you decide and plan the changes you want to make.
The aim is to build healthy habits that will fit in with your life and help you stay well in the future.
You should have a check-up for fatty liver disease at least once a year. This should include checks on your risk of developing a condition related to fatty liver disease.
Your GP can check your:
- weight and body mass index (BMI)
- blood glucose
- blood pressure
- blood lipids (cholesterol and triglycerides).
Every 3 years you should have testing for advanced fibrosis. This is to check that your condition is stable and not getting worse. This is important because there are often no symptoms to tell you or your clinical team that your liver is getting more damaged.
Hospital specialists manage care for later stage MASLD or NAFLD (secondary care)
This can include MASH or NASH with moderate or advanced fibrosis, and cirrhosis.
The level of scarring in your liver means you are at higher risk of liver failure or liver cancer. To reduce this risk it is very important to keep your weight in the healthy range, eat healthily and be physically active. As well as stopping your condition getting worse, it can still be possible to reverse some liver damage.
The main person in charge of your care will be a doctor who specialises in either the liver (hepatologist) or the digestive system (gastroenterologist). They may write you a care plan, which sets out what appointments you have and who else is in your Multidisciplinary Team (MDT).
Your MDT are there to give you any help you need to improve your MASLD. They can also help you to manage some other medical conditions alongside your MASLD. Your MDT could include:
- a specialist liver nurse
- a dietitian
- a psychologist
- a physical activity specialist.
People with cirrhosis should be offered scans to check for liver cancer every 6 months. This is called surveillance.
If you have or develop cirrhosis your clinical team will advise on what other treatment you need. Read more about cirrhosis.
How is fatty liver disease treated?
Treatment for fatty liver disease (MASLD or NAFLD) has 2 main aims:
- To stop the condition getting worse, so that it does not lead to liver cancer or liver failure.
- To help your liver repair as much of the damage as possible.
The main treatment is eating a healthy diet, being more physically active and (if needed) losing weight. This might seem like very general advice, but these steps all reduce liver fat and inflammation. For example, for people who are overweight, evidence shows losing 5 to 10% of their bodyweight can stop and sometimes even reverse liver damage.
There are currently no medicines available in the UK to specifically treat MASLD. But there is a lot of research being done to develop some. You can help by taking part in research. Ask your clinical team about clinical trials in your area or visit the Be Part of Research website.
How your care is managed depends on how serious your MASLD is and how much scarring (fibrosis) there is in your liver. Read about tests for scarring.
The most common cause of death in people with fatty liver disease is heart and circulatory disease. So it’s important to keep your heart healthy as well as your liver. Make sure that conditions such as heart disease, high blood pressure and type 2 diabetes are well managed. If you are managing multiple conditions tell your clinical team and ask them how they can help. Statins are safe for most people with fatty liver disease. If you have been prescribed statins it is important that you continue to take them. If you have any questions speak to your clinical team who can give advice tailored to you.
How healthy living can treat and reverse fatty liver disease
Whatever your weight, eating healthily and being more physically active can each help reduce liver fat and improve fatty liver disease. For most people these are the best ways to lose weight, if you need to.
Reducing liver fat takes away the root cause of fatty liver disease. By doing this, you reduce the strain on your liver and give it a chance to repair itself. Research shows all 3 of these things can slow, stop and even reverse MASLD and NAFLD.
Make small changes that you can stick with in the long term. Your clinical team are there to help you. And we have information and advice to support you every step of the way.
Keep a healthy weight
If you are overweight, the most important thing you can do to improve your condition is to lose weight. Research shows that losing 5 to 10% of your body weight can control and in some cases reverse MASLD.
If you are a healthy weight, it’s important to avoid gaining weight. This can make your fatty liver disease worse. Read more about keeping a healthy weight.
Eat a well-balanced diet
There is no magic diet or specific list of foods and drinks that will cure you or to avoid completely. Instead for most people a well-balanced diet is the best way to stay healthy and manage your weight.
The aim is to generally eat and drink healthily most of the time and not have too much or too little of anything. The overall picture is more important than any one small detail. If you are struggling to change your diet, ask to be referred to a dietitian. Find out more about how to eat a well-balanced diet.
Be more physically active
Aim to do at least 2½ hours of physical activity every week that gets you a bit out of breath. Brisk walking, team sports, swimming and dancing all count. You can break it down into smaller bouts of 10 minutes at a time.
Also do activities to strengthen your muscles twice a week. This could be things like yoga, chair exercises, working with weights or even carrying heavy shopping.
Don’t worry if you can’t do the target amount at first. Start small and build up the amount you do over time – remember that any activity is better than none.
Your doctor can advise you on types of activity that would suit you. Find out more about physical activity and exercise.
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Expert advice videos
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More information and advice
We have lots of information to help you understand fatty liver disease and improve your condition. From questions to ask your doctor to tips for getting more active, we’re here for you.
Click the links to download our booklets and factsheets. If you’d rather have a printed copy email info@britishlivertrust.org.uk and we can post it to you.
We are in the process of updating our publications to use the new names, some of our publications will still use the terms NAFLD and NASH.
Booklets
Your guide to NAFLD, NASH and fatty liver disease
Treating NAFLD with a healthy diet and physical activity
Factsheets and other resources
Eating healthily and NAFLD – getting started
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