Fatty liver disease is increasingly common, yet still widely misunderstood. Many people are surprised to learn they have fat accumulating in their liver — particularly if they don’t drink much alcohol and don’t consider themselves “unhealthy”.
In recent years, the medical community has updated the terminology used to describe this condition. What was previously known as non-alcoholic fatty liver disease (NAFLD) is now more commonly referred to as metabolic dysfunction–associated steatotic liver disease (MASLD).
This change is more than just a name update. It reflects a growing understanding of what actually drives fat accumulation in the liver.
Why the Name Changed
The older term non-alcoholic fatty liver disease defined the condition by what it wasn’t — alcohol-related — rather than what it is.
MASLD shifts the focus to the underlying issue:
metabolic dysfunction.
In other words, fat builds up in the liver not because of alcohol intake, but because the liver is struggling to manage energy, blood sugar, fats, and inflammatory signals efficiently.
This reframing is important because it:
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Reduces stigma and blame
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Moves attention away from alcohol alone
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Highlights the role of metabolic health
What Does “Metabolic Dysfunction” Mean?
Metabolism refers to how the body processes and uses energy. When metabolic processes become inefficient or overloaded, the liver often bears the brunt.
In practice, metabolic dysfunction may involve:
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Impaired blood sugar regulation
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Insulin resistance
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Elevated triglycerides
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Increased visceral (abdominal) fat
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Chronic low-grade inflammation
Over time, these factors can lead to excess fat being stored in liver cells.
MASLD Is Common — Even in People Who Feel Well
MASLD often develops silently. Many people have no obvious symptoms, and routine liver blood tests can appear normal, particularly in the early stages.
Others may experience non-specific symptoms such as:
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Persistent fatigue
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Brain fog
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Digestive discomfort
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Hormonal imbalances
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Skin concerns
Because these symptoms don’t obviously point to the liver, MASLD is frequently overlooked.
Not Just a Liver Condition
Although the liver is central to MASLD, this condition rarely exists in isolation.
The liver plays a key role in:
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Blood sugar regulation
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Fat metabolism
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Hormone clearance
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Inflammatory signalling
When liver function is under strain, the effects can be felt throughout the body. This is why MASLD is often associated with conditions such as type 2 diabetes, cardiovascular disease, polycystic ovary syndrome, and metabolic syndrome.
A Shift in Perspective
Viewing fatty liver disease through a metabolic lens encourages a more compassionate and effective approach.
Rather than focusing solely on weight or calorie intake, it invites us to consider:
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How the body is processing carbohydrates and fats
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The role of insulin and blood sugar balance
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Gut–liver communication
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Inflammatory and oxidative stress load
This broader perspective opens the door to more personalised, sustainable support strategies.
In Summary
MASLD reflects a modern understanding of fatty liver disease as a condition rooted in metabolic dysfunction rather than alcohol intake alone.
As awareness grows, so does the opportunity to address liver health earlier and more effectively — long before serious liver damage occurs.
In future articles, I’ll explore how fat builds up in the liver, the connection between liver health and blood sugar, and the often-overlooked role of the gut and bile flow in metabolic health.
Karen
Registered Nutritional Therapist
I have a particular professional interest in liver and metabolic health from a functional nutrition perspective.