Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly called NAFLD, and type 2 diabetes often occur together because they share common risk factors such as obesity and insulin resistance.

Living with diabetes can increase the risk of various complications, including metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease (NAFLD).

In this condition, excess fat builds up in the liver. Around 24% of people in the United States have MASLD. But for adults who live with both obesity and type 2 diabetes, the estimates are greater than 70%.

This article will investigate the association between MASLD and diabetes, whether one condition affects the other, and how they can be managed effectively.

NAFLD to MASLD name change

Nonalcoholic fatty liver disease (NAFLD) is now known as metabolic dysfunction–associated steatotic liver disease (MASLD). This new name is more accurate and helps reduce the stigma associated with its older name.

According to the American Association for the Study of Liver Diseases (AASLD), the name change took effect in June 2023 and was agreed upon by a group of multinational liver societies and organizations.

MASLD is a condition where too much fat builds up in the liver. Unlike alcohol-related liver disease, MASLD develops in people who do not drink heavily, and it is linked to metabolic factors such as:

  • obesity
  • type 2 diabetes
  • high cholesterol

MASLD is sometimes called fatty liver disease or hepatic steatosis.

MASLD is becoming more common in Western countries, especially in the United States. It is one of the most common forms of liver disease in the country.

Up to two-thirds of people with type 2 diabetes have MASLD, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

MASLD is strongly tied to obesity, insulin resistance, and Type 2 diabetes. While it can occur in people with Type 1 diabetes, the relationship is less direct.

People with Type 1 diabetes who also have overweight/obesity, insulin resistance, or metabolic syndrome are at higher risk — but Type 1 diabetes itself is not the main driver or cause of MASLD.

Some people with MASLD may develop a more aggressive form called . This condition involves not only fat buildup in the liver but also inflammation and liver cell damage.

MASH may progress to liver scarring and damage (cirrhosis) and liver failure, which can be life-threatening.

The main cause of MASLD in people with diabetes is overweight or obesity. Weight loss is one way to slow the progression or reverse the development of MASLD.

Studies show that losing just 7% to 10% of your body weight is the best way to achieve sustained weight loss. You can do this through regular physical exercise and calorie restriction.

High fructose consumption is also associated with the development of MASLD. Limiting or avoiding high-sugar foods and drinks, like processed foods and sodas, can also help prevent or slow the progression of MASLD.

MASLD is also common in people with high blood pressure and cholesterol. If you have MASLD and it has progressed to MASH, some studies have linked taking statins to improved liver function and reduced cardiovascular events. Research notes that those statin-related benefits are specific to people without any liver issues after 3 years.

Oftentimes, MASLD has no symptoms until it has progressed to advanced stages (cirrhosis or liver failure).

Symptoms of advanced liver disease include:

  • nausea
  • weight loss
  • loss of appetite
  • yellowing of the skin and whites of the eyes (jaundice)
  • swollen abdomen and legs
  • mental confusion
  • extreme fatigue
  • muscle weakness

If you’re experiencing any of these symptoms and have risk factors for MASLD contact your doctor for further testing.

What are the risk factors for MASLD?

Risk factors for MASLD include:

  • high blood pressure
  • high cholesterol
  • overweight or obesity
  • type 2 diabetes

Having MASLD may not change your daily blood sugar levels at first, but the condition can get worse over time. High blood sugar, such as in people living with diabetes, is one factor that can contribute to its progression.

One 2021 study found that the average 3-month blood glucose levels of people with MASLD determined their likelihood of having more severe cirrhosis, which can lead to liver failure.

A 2019 study found that MASLD can lead to the overproduction of glucose, leading to insulin resistance and abnormal blood sugar levels. Over time, this can develop into prediabetes and type 2 diabetes.

In short, MASLD and diabetes do not directly cause each other, but when they occur together, they can make each condition worse and harder to manage.

There’s no particular meal plan for managing both diabetes and MASLD. Rather, one goal is to lose and manage weight to help slow the progression of both conditions.

One way you can manage your weight is by eating a balanced, nutritious diet. Whole foods are one way to do this. Consider adding more of these foods to your diet:

  • fruits and vegetables
  • lean proteins like chicken, white fish, and turkey
  • lentils and legumes
  • whole grains
  • healthy fats, like extra-virgin olive oil, seeds, and nuts

If you smoke or drink alcohol, it’s important to quit. Quitting smoking and drinking can be difficult, but you don’t have to do it alone. Your doctor can help you create a quit plan that works for you and your needs.

Doctors also advise limiting or avoiding foods high in saturated fats and sugar, like:

  • cookies
  • cakes
  • ice creams
  • other desserts

There are no medications that can reverse MASLD. But you can help slow its progression and, in some cases, reverse its damage with certain lifestyle strategies. These include:

  • managing your weight
  • eating a balanced, nutritious diet
  • increasing your physical activity
  • managing your blood sugar, blood pressure, and cholesterol levels

Most healthcare professionals recommend losing 3% to 5% of your body weight to see results in the liver. However, it’s important to lose weight sustainably. Rapid weight loss may actually make MASLD worse, so aim to lose no more than 1 to 2 pounds per week.

Your doctor can help you plan the healthiest and most sustainable weight loss options for you.

One 2014 pilot study out of Japan suggests that taking a glucagon-like peptide-1 (GLP-1) analog can help with weight loss in people with diabetes and MASLD.

Researchers in a 2013 study pointed out that taking thiazolidinediones, a drug for type 2 diabetes, may be beneficial for people who also have MASLD. These medications help reduce insulin resistance and may lead to weight loss.

According to a 2014 study, dipeptidyl peptidase-4 (DPP-4) inhibitors may be beneficial if you have MASLD and type 2 diabetes because they can lead to:

  • weight loss
  • reduced body mass index (BMI)
  • improved HbA1c levels

Taking these steps in the beginning stages of MASLD can prevent permanent damage to your liver.

MASLD affects up to two-thirds of people with type 2 diabetes. MASLD often does not have any symptoms in its beginning stages, but it can lead to liver failure when not treated.

Higher blood sugars can also make MASLD more difficult to treat, and having MASLD can increase blood sugars.

The best treatment for MASLD is weight loss. Eating a balanced diet and getting more exercise into your daily routine can help you manage your weight.

You may also want to talk with your doctor about taking certain medications, such as GLP-1 analogs, thiazolidinediones, or dipeptidyl peptidase-4 (DPP-4) inhibitors, to help you lose weight and improve insulin sensitivity.

When not treated, MASLD can lead to metabolic dysfunction–associated steatohepatitis (MASH), an aggressive form of MASLD. It may also progress to cirrhosis and liver failure, which can be life-threatening.