Steatotic (Fatty) Liver Disease

What is steatotic (fatty) liver disease?

Steatotic liver disease (SLD) includes several conditions associated with steatosis in your liver. “Steatosis” is a term healthcare providers use to describe fat buildup in an organ (usually your liver). A healthy, high-functioning liver contains a small amount of fat. Fat buildup becomes a problem when it reaches over 5% of your liver’s weight.

Why was fatty liver disease renamed steatotic liver disease?

Previously, steatotic liver disease was known as “fatty liver disease.” In 2023, experts renamed the condition and its subcategories to reflect its causes more accurately. For example, while some conditions associated with fat composition in your body (like obesity) can increase your risk of steatosis, there are several risk factors unrelated to weight or body mass index (BMI).

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The renaming also avoids language that’s potentially stigmatizing toward people with SLD.

What are the types of steatotic (fatty) liver disease?

Healthcare providers classify SLD based on its causes and the conditions associated with it.

Alcohol-related liver disease (ALD)

With ALD, steatosis occurs because of excessive alcohol consumption. Each time your liver filters alcohol, some of its cells die. Usually, your liver can make new cells to replace the old ones, so there isn’t a problem. But if you drink too much alcohol, your liver may not be able to keep up. Instead, steatosis may set in.

Metabolic dysfunction-associated steatotic liver disease (MASLD)

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Previously, healthcare providers referred to MASLD as non-alcohol related fatty liver disease (NASLD) because the steatosis isn’t associated with heavy alcohol consumption. Experts renamed the condition to reflect what the fat buildup in your liver is associated with. With MASLD, the culprit is cardiometabolic risk factors. These factors include conditions and characteristics that pose risks to your heart health.

Risk factors associated with MASLD include:

• Obesity.
• Type 2 diabetes.
• High blood pressure.
• Lipid abnormalities (lipids are fatty compounds found in cells).

MASLD also applies if you consume small amounts of alcohol weekly. “Small amounts” means less than 140 grams per week for people assigned female at birth (AFAB) and less than 210 grams per week for people assigned male at birth (AMAB). For reference, in the U.S., one standard, 12-oz. beer contains about 14 grams of alcohol.

Metabolic-associated steatohepatitis (MASH)

Metabolic-associated steatohepatitis (MASH) is a serious form of MASLD. With MASH, fat buildup progresses to inflammation, then tissue damage and scarring (fibrosis). Previously, healthcare providers referred to MASH as non-alcohol related steatohepatitis (NASH).

MASLD and increased alcohol intake (MetALD)

If you have MetALD, both metabolic risk factors and alcohol consumption play a role in fat buildup in your liver. With MetALD, you have a cardiometabolic risk factor and consume more than 140 grams per week (AFAB) or more than 210 grams per week (AMAB).

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What contributes most to the fat buildup in your liver (alcohol consumption or metabolic risk factors) varies from person to person.

Other forms of SLD

SLD can result from causes other than alcohol use or cardiometabolic risk factors. For example, various medications and diseases can cause steatosis. Sometimes, healthcare providers can’t identify a specific cause. SLD without a clear cause is called cryptogenic SLD.

Is steatotic (fatty) liver disease a serious problem?

In most cases, the fat buildup doesn’t cause serious problems or prevent your liver from functioning normally.

In some cases, the condition progresses to liver disease. It usually progresses in stages:

1. Hepatitis: Your liver goes from fatty to inflamed (swollen). The inflammation damages tissue. This stage is called steatohepatitis. For example, this is what happens when MASLD becomes MASH.
2. Fibrosis: Bands of scar tissue form where the inflammation damages your liver, causing it to stiffen. This process is called fibrosis.
3. Cirrhosis: Extensive scar tissue replaces healthy tissue. At this point, you have cirrhosis of the liver. Without treatment, cirrhosis can lead to potentially fatal conditions like liver failure and liver cancer. About 90% of people who develop hepatocellular carcinoma (HCC) — a type of liver cancer — have cirrhosis.

This is why it’s so important to learn what’s causing fat buildup in your liver and get treated. Even if you have early-stage cirrhosis, there are steps you can take to protect your liver from further damage. In some instances, you can even reverse some damage by following your provider’s treatment plan for you.

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