Steatotic liver disease (SLD) involves having excess fat in your liver. Metabolic conditions and heavy alcohol use are risk factors. Depending on the type of SLD you have, the fat buildup may not cause problems, or it may lead to liver damage. Often, you can prevent or even reverse SLD with medications and lifestyle changes.
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.
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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).
The renaming also avoids language that’s potentially stigmatizing toward people with SLD.
Healthcare providers classify SLD based on its causes and the conditions associated with it.
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.
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:
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) 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).
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).
What contributes most to the fat buildup in your liver (alcohol consumption or metabolic risk factors) varies from person to person.
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.
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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:
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.
SLD doesn’t always cause symptoms. When they’re present, symptoms include:
More commonly, people notice symptoms once SLD has progressed to cirrhosis of the liver. When cirrhosis develops, you may experience:
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SLD has multiple causes. Still, you’re more likely to develop SLD if you have a cardiometabolic risk factor, if you consume unhealthy amounts of alcohol or both.
You have a greater chance of developing SLD if you:
Without treatment, a steatotic liver can progress to cirrhosis of the liver, which can lead to liver failure, liver cancer and cancers outside your liver. People with MASLD are also at increased risk of heart disease. Heart disease — not liver disease — is the leading cause of death in people with MASLD.
Because SLD doesn’t usually cause symptoms, your healthcare provider may be the first to notice an issue. High levels of liver enzymes that turn up on a blood test for other conditions may raise a red flag. Elevated liver enzymes are a sign your liver is injured.
To make a diagnosis, your provider may perform:
There’s no specific treatment or medications. Instead, providers focus on helping you manage risk factors that contribute to the condition. This includes making lifestyle changes that can improve your health.
Your provider may recommend that you:
Your provider may change your prescriptions if your medicine is causing fat to accumulate in your liver.
The best way to avoid SLD is to maintain your overall health:
Depending on the severity of your condition, it’s possible to get rid of SLD and even some scarring. Your liver has an amazing ability to repair itself. If you follow your provider’s treatment plan, it’s possible to reduce liver fat and inflammation. You can prevent the damage from worsening and, in some cases, reverse early liver damage.
SLD doesn’t cause major problems for most people unless they develop advanced cirrhosis. Many people with SLD have a normal life expectancy.
Untreated cirrhosis of the liver eventually leads to liver failure or liver cancer. Your liver is an organ you can’t live without. This is why it’s so important to protect your liver if you learn you have SLD.
If your SLD is weight-related, follow a balanced diet to lose weight slowly but steadily. Healthcare providers often recommend steering clear of sugar and trying the Mediterranean diet, which is high in vegetables, fruits and good fats. Other foods and diets rich with nuts, seeds, whole grains, and fish and chicken are helpful food choices for SLD. It’s also important to avoid eating too much red meat or drinking sugary beverages.
Ask your doctor or nutritionist for advice on healthy weight loss techniques.
Questions include:
A note from Cleveland Clinic
Consider steatotic liver disease a warning sign that can help you take steps to avoid a fatal liver condition like cirrhosis or liver cancer. Having too much fat in your liver isn’t the same as scarring — which is much more serious. Work with your healthcare provider to understand if you’re at risk of developing inflammation or scarring in your liver. If you are, focus on managing causes and contributing factors, including alcohol use and metabolic syndromes. You can take steps to protect your liver, improve your health and even potentially save your life.
Last reviewed on 09/27/2023.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy