Fatty liver disease, or MASLD, involves excess fat in liver cells, often associated with metabolic syndrome and increasing heart disease risk. Management prioritizes lifestyle changes including diet and exercise, and evaluation of liver scarring is crucial for prognosis.

Fatty liver disease, or MASLD, involves excess fat in liver cells, often associated with metabolic syndrome and increasing heart disease risk. Management prioritizes lifestyle changes including diet and exercise, and evaluation of liver scarring is crucial for prognosis.

Fatty liver disease, or MASLD, involves excess fat in liver cells, often associated with metabolic syndrome and increasing heart disease risk. Management prioritizes lifestyle changes including diet and exercise, and evaluation of liver scarring is crucial for prognosis.

Fatty liver disease occurs when excessive fat builds up in liver cells. Often causing no symptoms, it is frequently discovered during an ultrasound. Over time, some individuals develop inflammation and scarring.

MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) is the updated term for fatty liver linked to excess weight, elevated blood sugar, or unhealthy blood fat levels. Alcohol and certain medications can also cause or worsen the condition. A key driver is metabolic syndrome—defined as having at least three of five conditions: a large waistline, high blood pressure, elevated blood sugar, high triglycerides, and low HDL ('good') cholesterol. These factors trigger insulin resistance, raising blood sugar and driving extra fat into the liver. However, fatty liver can still occur without metabolic syndrome.  

The heart connection and risk factors

Having a fatty liver increases the likelihood of heart and blood vessel disease due to shared risk factors like diabetes, high blood pressure, abdominal fat, unhealthy cholesterol, and inflammation.

While a heart attack is not inevitable, a fatty liver diagnosis serves as a vital wake-up call. Normal weight or a single healthy cholesterol reading does not rule out risk. Fatty liver can occur in normal-weight individuals carrying hidden abdominal fat, a pattern particularly relevant in South Asians. Sedentary lifestyles, large portions, sugary beverages, sweets, fried snacks, poor sleep, and family history all heighten risk. 

Understanding scan grades and scarring

An ultrasound grade only indicates how fatty the liver looks, not its level of inflammation or scarring (fibrosis). Thus, a 'Grade 1' result still requires follow-up.

Evaluating scarring is critical for estimating future liver risk. Advanced scarring leads to cirrhosis, requiring specialist care. A non-invasive fibroscan or a FIB-4 blood calculation is used to assess scarring.

Scarring checks are crucial for people with type 2 diabetes, obesity with additional metabolic risks, prediabetes, or persistent abnormal liver blood tests. A waist measurement ≥90 cm in Indian men or ≥80 cm in Indian women indicates increased metabolic risk. Doctors will evaluate weight, waist size, blood pressure, blood sugar (HbA1c), and lipid profiles. 

Managing heart health and lifestyle

Symptom-free patients do not automatically need advanced heart tests like ECGs or treadmill tests; doctors evaluate overall risk profiles first.

Lifestyle modifications remain the primary strategy:   

Dietary adjustments: Avoid crash diets. Reduce oversized portions of refined carbohydrates (rice, maida) and increase vegetables, whole grains, and pulses. Swap sugary juices for whole fruits and water. Limit bakery foods, fried snacks, and saturated fats like coconut oil.   

Physical activity: Aim for 150 to 300 minutes of moderate activity weekly (e.g., 30 minutes of brisk walking 5 days a week) alongside strength training 2 days a week. Exercise reduces liver fat even if body weight changes minimally.   

Medications, alcohol, and children

Continue prescribed treatments for diabetes, blood pressure, and cholesterol. Statins are generally safe in fatty liver disease and help protect the heart. Avoiding alcohol completely is safest, as it accelerates liver damage.  

Children with obesity can also develop fatty liver. Screening via ALT blood tests may begin between ages 9–11 for high-risk children. Dark, velvety skin around the neck can signal insulin resistance.

Families should adopt healthy habits together without resorting to blame or crash diets. Finally, avoid unproven 'liver detox' drinks or tonics, which can cause liver harm.

While regular coffee consumption is associated with lower scarring risks, it is not a direct treatment. Following a diagnosis, review your results with a doctor to establish an individualised care plan.

(The author is a senior consultant, Hepatology and Liver Transplantation, Aster Medcity, Kochi)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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