Obesity, type 2 diabetes, and certain lifestyle habits can increase your risk of metabolic dysfunction-associated steatotic liver disease (MASLD).

MASLD, formally called nonalcoholic fatty liver disease (NAFLD), affects nearly 40% of adults and up to 14% of children and adolescents worldwide, according to a 2024 review.

MASLD occurs when excess fat builds up in the liver without heavy alcohol use. Many people with the condition don’t notice any symptoms, but some may experience abdominal pain or fatigue.

Certain health conditions can raise the risk of MASLD and often occur alongside it. These include:

  • overweight or obesity
  • high blood sugar
  • high cholesterol
  • high triglycerides
  • high blood pressure

Experts changed the name of the condition from NAFLD to MASLD to focus on the metabolic risk factors and reduce negative or stigmatizing language.

Researchers are still learning the exact causes of MASLD, but certain metabolic changes, health conditions, lifestyle habits, and even genetics can increase the risk. Managing these risk factors may help prevent or treat MASLD and lower the likelihood of complications.

One of the most serious complications is metabolic dysfunction-associated steatohepatitis (MASH), a more severe form of MASLD that can cause liver damage and scarring. Severe scarring may eventually lead to liver failure or liver cancer.

Read on to learn more about what raises your risk for MASLD.

Metabolism refers to chemical reactions that let your cells use, process, and store nutrients like fat and sugar. Changes in metabolism appear to play a key role in MASLD.

Having one or more of the following metabolic risk factors can raise your risk.

Overweight or obesity

Overweight and obesity occur when the size and number of fat cells increase. This can cause fat to build up in organs, including your liver.

A high body mass index (BMI) and large waist circumference are two common signs, though other factors also affect these measures. In adults:

  • overweight typically refers to a BMI of 25 to <30
  • obesity typically involves a BMI of 30 or higher
  • a large waist circumference is greater than 40 inches for males or greater than 35 inches for females

If you’re concerned about your weight or waist size, talk with your doctor. They may suggest changes to your diet, physical activity, or other habits, and in some cases, recommend medication or surgery.

Even small amounts of weight loss can help. Losing 3% to 5% of your body weight may reduce liver fat, while losing 10% or more may provide additional benefits. However, be cautious about losing weight too quickly, since rapid weight loss may worsen MASLD. Your doctor can guide you on safe, effective options.

Insulin resistance, prediabetes, or type 2 diabetes

Insulin resistance develops when your cells don’t respond well to insulin, which raises your blood sugar levels. It can also lead to:

  • weight gain
  • increased blood sugar
  • fat moving from your bloodstream into your liver
  • your liver making more fat molecules

Insulin resistance can progress to prediabetes and type 2 diabetes. Prediabetes means your blood sugar levels are higher than usual but not yet high enough for a diabetes diagnosis.

A 2024 review found that about two-thirds of people with type 2 diabetes also have MASLD.

Your doctor can recommend steps to prevent or manage prediabetes and type 2 diabetes, often through a combination of weight loss, lifestyle changes, and medication. Certain diabetes treatments may also help reduce liver fat in some people with MASLD.

High blood lipids

Cholesterol and triglycerides are types of lipids, or fats, in your blood. Your risk of MASLD is higher if you have:

  • high triglycerides
  • high total cholesterol
  • high low-density lipoprotein (LDL, or “bad”) cholesterol
  • low high-density lipoprotein (HDL, or “good”) cholesterol

Your doctor may order blood tests to check your lipid levels. If they’re high, treatment may involve diet, exercise, and sometimes medication.

High blood pressure

High blood pressure (hypertension) often occurs alongside MASLD. It also raises the risk that MASLD will progress to MASH and cause liver scarring (fibrosis).

Your doctor will check your blood pressure during routine visits. If it’s high, they may recommend lifestyle changes or prescribe medication to help lower it.

Certain health conditions may also raise your risk of MASLD. These include:

MASLD isn’t the only condition that can lead to fat buildup in the liver. Other possible causes include:

  • celiac disease
  • Wilson’s disease
  • glycogen storage disorders
  • homocystinuria (a rare inherited disorder that affects amino acid metabolism)

If you have any of these conditions, talk with your doctor. They can help you manage the condition and support your liver health.

Certain lifestyle habits can increase your risk of MASLD and other chronic liver conditions. These include:

  • low physical activity
  • a diet that is:
    • low in dietary fiber
    • high in refined grains
    • high in red or processed meat

Some research also suggests that smoking and insufficient quality sleep may raise the risk of MASLD or make it progress more quickly.

Excessive alcohol use can also cause fat to build up. When heavy drinking occurs alongside metabolic dysfunction, the condition is called metabolic dysfunction and alcohol-associated liver disease (MetALD).

Practicing healthy habits may help prevent or manage MASLD. Try to:

  • limit how much time you spend sitting each day
  • aim for at least 150 minutes of moderate physical activity, 75 minutes of vigorous activity, or a combination of both each week
  • follow a nutrient-rich diet with plenty of fruits, vegetables, whole grains, lean proteins, and unsaturated fats
  • limit refined grains, added sugars, and trans and saturated fats.
  • get 7 to 9 hours of quality sleep each night
  • avoid smoking and other tobacco products
  • limit or avoid alcohol

If making lifestyle changes feels difficult, let your doctor know. They can connect you with a specialist or support resources.

Having a family member with MASLD or severe liver scarring may increase your risk of MASLD.

Shared environmental factors may partly explain this connection. For example, family members often have similar eating patterns, activity levels, and other lifestyle habits.

Research also shows that certain genetic changes can affect the risk of MASLD, and these changes can be passed from parents to children.

If you have a family history of liver disease, let your doctor know. They can help you watch for early signs and manage your liver health.

MASLD can develop at any age, including in children and teens. However, the risk increases as you get older.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common type of liver disease linked to metabolic changes. Your risk increases if you have any of the following:

  • overweight and obesity
  • insulin resistance, prediabetes, or type 2 diabetes
  • high cholesterol
  • high triglycerides
  • high blood pressure

Other health conditions, such as polycystic ovary syndrome (PCOS) or obstructive sleep apnea (OSA), may also raise your risk of MASLD. Lifestyle habits, including your diet, physical activity, sleep, and alcohol use, can play a role too.

Your doctor may recommend weight loss, lifestyle changes, medication, or other treatments to help prevent or manage MASLD. Talk with them about your risk factors and the best ways to protect your liver health.