Metabolic dysfunction-associated steatotic liver disease (MASLD), previously referred to as non-alcoholic fatty liver disease (NAFLD), is a condition in which excess fat accumulates in the liver and is associated with metabolic risk factors.[1,2]
MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH), in which inflammation and liver damage occur. MASH may further progress to liver fibrosis, cirrhosis and liver cancer.[2]
Global Impact
Steatotic liver disease (SLD), the broader group of liver diseases that includes MASLD, affects an estimated 1.7 billion people worldwide and is one of the fastest-growing causes of chronic liver disease globally.[1]
According to WHO, the burden of SLD is closely linked to obesity, type 2 diabetes, cardiovascular disease and other metabolic conditions, and is expected to increase further as these conditions become more prevalent.[1]
Impact in India
MASLD is an important public health concern in India. Government of India guidelines report that studies using the previous NAFLD definition have estimated its prevalence at approximately 9%–32% of the general population in India.[3]
Obesity and diabetes are major risk factors, and interventions for fatty liver disease have been incorporated within India's National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD).[3]
Risk Factors
Important risk factors for MASLD include:
- Overweight and obesity
- Insulin resistance and type 2 diabetes
- High blood pressure
- High triglycerides and abnormal cholesterol levels
- Metabolic syndrome
- Physical inactivity and unhealthy dietary patterns.[2,4]
Signs and Symptoms
MASLD is often a silent disease with few or no symptoms, particularly during its early stages.[4]
When symptoms occur, they may include:
- Fatigue
- Discomfort in the upper-right side of the abdomen.[4]
Complications
MASLD can progress to serious liver complications, including:
- Metabolic dysfunction-associated steatohepatitis (MASH)
- Liver fibrosis
- Cirrhosis
- Liver cancer.[1,2]
Diagnosis and Early Detection
MASLD can be evaluated using medical history, physical examination, blood tests and imaging tests.[5]
Blood tests may show increased liver enzymes, while imaging tests such as ultrasound, CT or MRI can detect fat accumulation in the liver. Non-invasive tests such as elastography may also be used to assess liver fibrosis.[5]
Prevention and Management
MASLD can often be prevented or managed through a healthy diet, regular physical activity and maintaining a healthy body weight.[6]
For people who are overweight or obese, losing approximately 3%–5% of body weight can reduce fat in the liver, while a weight loss of approximately 7%–10% may be needed to reduce liver inflammation and fibrosis.[6]
Management also involves addressing associated metabolic risk factors such as obesity, diabetes, high blood pressure and abnormal blood lipid levels.[2,3]
References
- World Health Organization. Seventy-ninth World Health Assembly – daily update: 21 May 2026. Geneva: World Health Organization; 2026. Available from: https://www.who.int/philippines/news/detail-global/21-05-2026-seventy-ninth-world-health-assembly---daily-update--21-may-2026
- National Institute of Diabetes and Digestive and Kidney Diseases. Nonalcoholic fatty liver disease (NAFLD) & NASH [Internet]. Bethesda (MD): National Institutes of Health. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
- Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Non-Communicable Diseases: operational guidelines. New Delhi: Ministry of Health and Family Welfare, Government of India. Available from: https://www.mohfw-dohfw.gov.in/static/uploads/2025/11/e69c5e28bff4da319ea13d2956def528.pdf
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of NAFLD & NASH. Bethesda (MD): National Institutes of Health. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes
- National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of NAFLD & NASH. Bethesda (MD): National Institutes of Health. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for NAFLD & NASH. Bethesda (MD): National Institutes of Health. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/treatment