Metabolic Dysfunction Associated Steatotic Liver Disease

Formerly Known as Nonalcoholic Fatty Liver Disease

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Duke hepatologists are experts at diagnosing and treating metabolic dysfunction associated steatotic liver disease (MASLD), which was previously called nonalcoholic fatty liver disease (NAFLD). It is a leading cause of long-term liver damage in the U.S. and occurs in people who drink little or no alcohol. The often silent condition can lead to serious and irreversible liver damage if left untreated. 

Duke hepatologists diagnose the condition, address the risk factors -- obesity, Type 2 diabetes, hypertension, high cholesterol, and sleep apnea-- and help you manage MASLD before permanent liver damage occurs. 

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Related Liver Diseases

Metabolic dysfunction-associated steatohepatitis (MASH) -- formerly known as nonalcoholic steatohepatitis (NASH) -- is the aggressive form of MASLD. It can lead to liver inflammation, advanced liver scarring (cirrhosis), and liver failure. MASH is the fastest-growing cause of liver cancer and leads to more liver transplants than any other liver disease. 

MetALD is the development of fat in the liver as a result of alcohol use and MASLD. People typically drink alcohol and have metabolic risk factors. MetALD can result in fat in the liver inflammation, scarring, and cirrhosis.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

When to See Your Doctor

Ask your doctor about being tested for liver disease if you have risk factors, especially Type 2 diabetes and obesity, or if you feel fatigued or have abdominal pain or swelling, jaundice (yellowing of the skin or eyes), or dark urine. Our hepatologists work with your primary care provider, endocrinologists, and cardiologists to diagnose fatty liver disease and address the causes as soon as possible. 

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Diagnosing Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD)

Your doctor will ask you questions about your medical history and perform a physical exam. They may recommend one or more of the following tests.

Fibrosis 4 (FIB4) Index

FIB4 uses your age and common blood tests, including liver enzymes and platelet count, to determine your risk for developing liver scarring. This test is recommended in ALL patients with type 2 diabetes, complicated obesity, or risk factors for MASLD.


This ultrasound test assesses liver stiffness in your liver, which corresponds to liver scarring. It is available in liver clinics.


Your Duke doctor will use advanced MRI-based technologies to accurately determine the amount of liver scarring without doing a liver biopsy. 

Liver Biopsy

A small piece of liver tissue is removed using a thin needle inserted through the abdomen. A biopsy can show the extent of liver scarring and help confirm a diagnosis.

Best Hospital for Gastroenterology and GI Surgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our gastroenterology and GI surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

Treatments for Metabolic Dysfunction Associated Steatotic Liver Disease

Controlling risk factors can improve symptoms and halt the progression of liver damage.

Lifestyle Interventions

A healthy lifestyle, including eliminating saturated fats, high fructose corn syrup, and sweetened beverages from your diet, is essential for controlling metabolic dysfunction associated steatotic liver disease and preventing it from progressing. Our hepatologists can help you make healthy food choices and incorporate fitness into your life. Daily movement can help control the disease, even if you do not make significant changes to your diet. 

Weight Loss

Losing 10% of your body weight can reduce fat, inflammation, and scarring in the liver. Weight loss drugs and weight loss surgeries have shown promise for addressing metabolic dysfunction associated steatotic liver disease. Our hepatologists can refer you to weight loss specialists to help you manage your weight and control your liver disease. We offer a full range of options for weight control, from dietary changes to bariatric surgery.

Improving Cardiovascular Health

Heart diseases such as hypertension and high cholesterol increase your risk for metabolic dysfunction associated steatotic liver disease. That’s why our hepatologists work with Duke cardiologists to help you prevent or manage heart disease. This may include taking prescription medications like statins or ACE inhibitors, enrolling in a smoking cessation program, or managing stress.

Liver Transplant 

A liver transplant may be the best option if you have advanced cirrhosis. Your treatment team will carefully evaluate your condition to determine if this is the right option for you.

Why Choose Duke

A Team of Liver Specialists
A range of Duke specialists work together to give you the highest level of care. Our hepatologists, endocrinologists, cardiologists, weight loss specialists, dietitians, surgeons, and others design a care plan that considers not just your physical condition but also your quality of life.

Weight Loss Surgery and Liver Transplantation
We are one of a few centers in North Carolina to offer weight loss surgery before or in combination with liver transplantation to treat your liver disease and the cause of the disease. Bariatric surgery may help you successfully manage your weight and protect the health of your newly transplanted liver.

Active Researchers
As recognized leaders in liver disease research and treatment, we strive to improve care for people with liver disease. We are actively investigating risk factors associated with MASLD and evaluating new therapies to treat subsequent liver injury. We are also at the forefront of developing and implementing non-invasive tests to replace or supplement liver biopsy.

This page was medically reviewed on 02/09/2024 by