Metabolic-Related Fatty Liver Disease


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Fatty liver disease can occur when fat builds up in the liver as a result of metabolic issues such as Type 2 diabetes, obesity, hypertension, and high cholesterol. If you have these conditions, you should ask your doctor if you should be tested for metabolic-related fatty liver disease. Often, fatty liver disease does not cause symptoms, but it can lead to serious and irreversible liver damage if left untreated. Duke hepatologists are experts at diagnosing this often-silent condition, addressing risk factors, and treating the disease before permanent liver damage occurs. 

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Types of Metabolic-Related Fatty Liver Diseases

Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the leading causes of long-term liver damage in the U.S. and occurs in people who drink little or no alcohol. The condition develops slowly and may not cause any symptoms until significant liver damage occurs. Obesity, Type 2 diabetes, hypertension, sleep apnea, and high cholesterol are all risk factors for the disease. Untreated, it can lead to serious liver damage.

Metabolic dysfunction-associated steatohepatitis (MASH) -- formerly known as nonalcoholic steatohepatitis (NASH) -- occurs when MASLD progresses. It can cause 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.   

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

When to See Your Doctor

Talk to your doctor about getting 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-Related Fatty Liver Disease

Treatments Overview

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.

Risk Factor Assessment


Your doctor will explore your health history to determine if you have one or more risk factors. Based on this information, they may recommend additional testing for related conditions, such as sleep apnea and heart disease.

Fibrosis 4 (FIB4) Index


FIB4 uses your age and common blood tests, including liver enzymes and platelet count, to determine your risk for developing advanced liver disease. This first-line test is recommended if you are at risk for metabolic-related fatty liver disease. 



Ultrasound images assess stiffness in your liver, which corresponds to liver scarring.



Magnetic resonance imaging (MRI) produces detailed pictures of the liver and can detect even mild fat buildup, as well as cirrhosis, problems with the blood vessels and bile ducts, and other liver conditions.

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.

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Treatments for Metabolic-Related Fatty Liver Disease

Treatments Overview

There are no medications to treat metabolic-related fatty liver disease or repair liver damage. However, 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-related fatty 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 nonalcohol fatty liver disease. Our hepatologists can refer you to weight loss specialists to help you manage your weight and control your liver disease. We offer the 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-related fatty 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 10/01/2023 by