Lifestyle changes, medications, and emerging therapies can help treat or reverse metabolic dysfunction-associated steatotic liver disease (MASLD) for some people.

Metabolic dysfunction-associated steatotic liver disease (MASLD), once called nonalcoholic fatty liver disease (NAFLD), occurs when fat builds up inside the liver. It’s different from alcohol-associated liver disease (ALD), which develops from drinking excess alcohol.

In 2023, experts replaced the term NAFLD with MASLD to reduce stigma, improve diagnosis, and better reflect the root causes of the condition.

MASLD develops when the body’s metabolic system, which manages how energy is used and stored, isn’t working properly. Conditions, such as type 2 diabetes and obesity, raise the risk of MASLD.

Without treatment, MASLD can progress to more serious conditions, including metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, or liver cancer.

However, with treatment, MASLD can often improve or even be reversed before it causes permanent liver damage.

The primary goals of treatment for MASLD are to:

  • reduce liver fat
  • improve metabolic health to prevent new fat buildup
  • slow or stop disease progression

To understand these goals, it helps to know why fat collects in the liver.

Your liver naturally contains some fat, usually up to about 5% to 10% of its weight. However, excess fat interferes with how this organ works. As fat builds up, the lever becomes less effective at carrying out its usual functions. Over time, this stress can trigger long-term inflammation and damage liver cells.

In MASLD, fat buildup is linked to metabolic factors that raise levels of free fatty acids and triglycerides in the blood. Contributing factors include insulin resistance, diets high in saturated fats, certain genetic traits, and problems in the digestive system.

Excess fat molecules travel through the bloodstream to the liver, where they build up and disrupt cell function. Some of these fat molecules are directly toxic to liver cells.

You may have a higher risk of MASLD if you live with:

  • prediabetes or type 2 diabetes
  • overweight or obesity
  • high LDL cholesterol or low HDL cholesterol
  • high blood pressure

Lifestyle plays a major role in the risk of MASLD. Many conditions linked to MASLD, such as type 2 diabetes, high cholesterol, or high blood pressure, are influenced by daily habits like diet and activity. Because of this, lifestyle changes are usually the first recommended treatment for MASLD.

Dietary approaches

What you eat can increase the amount of fat molecules traveling through your bloodstream to your liver. A 2024 review found that diets high in the following may contribute to MASLD:

  • saturated fats
  • processed meats
  • sweetened drinks
  • simple sugars and high glycemic-index carbs

While more research is needed before experts can recommend a single diet for everyone with MASLD, studies show that reducing calorie intake and following a balanced diet, such as the Mediterranean diet, can help.

The Mediterranean diet focuses on:

  • plant-based whole foods
  • healthy fats, like those in nuts and olive oil
  • regular fish and seafood
  • moderate amounts of eggs and poultry
  • limited red meat and dairy
  • herbs and spices for flavor instead of salt

Eating fewer calories than you burn helps the body use stored fat for energy, including fat in the liver. Calorie reduction can also improve how the body responds to insulin by lowering fat around organs and tissues.

Healthcare professionals recommend aiming to eat about 500 to 1,000 fewer calories than you burn each day to help support gradual weight loss. Research suggests that losing just 5% of your body weight may improve MASLD.

Exercise and physical activity

Exercise is another important lifestyle change for MASLD. Even without dietary changes, physical activity can improve muscle function, which helps the liver better regulate fat storage.

The type of exercise you do matters less than consistency. Both aerobic activities, like running, walking, or cycling, and resistance training, like weightlifting or body weight exercise, can reduce liver fat, support weight loss, and improve overall metabolic health.

General exercise recommendations for adults include:

  • 150 minutes of moderate-intensity physical activity each week, or
  • 75 minutes of vigorous-intensity physical activity each week, plus
  • at least 2 days of muscle-strengthening activity

Currently, there are no Food and Drug Administration (FDA)-approved medications for MASLD. Most drug research has focused on MASH, the more advanced form of the disease that involves liver damage and scarring.

At this time, the only FDA-approved treatments for MASH are resmetirom and semaglutide (Wegovy). Several other drugs are in development and being tested in clinical trials, including:

  • pegozafermin
  • lanifibranor
  • tirzepatide
  • efruxifermin

Lifestyle changes remain the main treatment for MASLD. Still, some medications may help manage conditions that raise the risk of fat buildup in the liver.

  • GLP-1 receptor agonists: These include semaglutide and are already used to treat type 2 diabetes and support weight loss, which can also improve MASLD.
  • Metformin: This is another diabetes medication that may help by improving how the body responds to insulin.

In some cases, surgery may be part of MASLD treatment, especially when diet and exercise haven’t led to enough improvement in metabolic health.

Bariatric surgery isn’t considered a first-line treatment for MASLD. However, doctors may recommend it for people with obesity who haven’t seen results with other options. This technique changes how the digestive system handles food. Depending on the type of surgery, it may:

  • make the stomach smaller so it holds less food
  • reroute part of the intestine to reduce calorie absorption

These changes lower calorie intake and affect gut hormones, which can improve insulin sensitivity and help the liver process fat more efficiently.

Some people with MASLD explore complementary or alternative therapies to support liver health and overall well-being.

It’s important to talk with a doctor before trying these options. Not every supplement or therapy is safe for everyone, and some may interact with certain medications or cause side effects.

A 2025 review found that the following supplements may help support liver health in MASLD:

  • coffee
  • green tea
  • vitamin E
  • omega-3 fatty acids
  • probiotics, prebiotics, and synbiotics

Self-care strategies may also play a role by supporting overall well-being and metabolic health. These can include:

  • stress management
  • getting enough quality sleep
  • relaxation techniques

Metabolic dysfunction-associated steatotic liver disease (MASLD) develops when excess fat builds up in the liver due to problems in how the body processes and stores energy.

Lifestyle changes, such as dietary adjustments and staying active, are the main treatments for MASLD. In some cases, medications or surgery may be necessary. Early detection and treatment can help slow, improve, or even reverse the condition before lasting damage occurs.