At a glance
- Fatty liver is common. What matters most is whether your liver has scarring (fibrosis). A blood test score called FIB-4, and sometimes a FibroScan, can check for it.
- If you are above a healthy weight, losing 5% of your weight lowers liver fat. Losing 7 to 10% helps inflammation, and 10% or more can help scarring.
- Eat a Mediterranean-style diet. Cut back on sugary drinks and highly processed foods.
- Aim for 150 minutes of activity a week, such as brisk walking. It helps your liver even if your weight doesn't change.
- Less alcohol is better. If you have liver scarring, don't drink at all.
- Look after your heart: blood pressure, cholesterol, blood sugar and not smoking. Heart disease is a bigger risk than liver disease for most people with MASLD.
- If you have type 2 diabetes, ask for a liver scarring check (FIB-4) every 1 to 2 years.
- Ask before taking supplements or herbal products for your liver. Statins are safe with fatty liver.
What is fatty liver disease?
Fatty liver disease means extra fat has built up in your liver. It is very common.
About 1 in 4
About 7 in 10
Doctors now call it MASLD, short for metabolic dysfunction-associated steatotic liver disease. “Steatotic” means fatty. “Metabolic” means it goes along with at least one of these:
- Extra weight, especially around the waist
- High blood sugar, prediabetes or type 2 diabetes
- High blood pressure
- High triglycerides (a type of fat in the blood)
- Low HDL (“good”) cholesterol
You may have heard the old name, NAFLD. The new name was chosen by liver experts around the world in 2023. If you have fatty liver and also drink a fair amount of alcohol, your doctor may call it MetALD.
Why does it matter?
For most people, fatty liver stays mild. But in some people, the fat causes inflammation and damage. This is called MASH (metabolic dysfunction-associated steatohepatitis). About 1 in 4 people with MASLD may go on to get MASH.
Over many years, MASH can cause scarring (fibrosis). Heavy scarring is called cirrhosis. The amount of scarring is the best guide to future liver problems. That is why your doctor will focus on checking for it.
The good news: fatty liver can get better. In its early stages, it can be reversed.
How do doctors check my liver?
Fatty liver is often found by chance, on an ultrasound or in liver blood tests. To check for scarring, doctors use two steps.
Step 1: FIB-4 score. This is worked out from your age and three common blood tests (two liver enzymes, AST and ALT, and your platelet count). It uses results from routine blood tests.
- Below 1.3Low chance of serious scarring. Your doctor may repeat it every 1 to 2 years.
- 1.3 to 2.67Not clear. You need a second test.
- Above 2.67Higher chance of scarring. You need a second test, and usually a liver specialist.
Step 2: FibroScan or ELF test. A FibroScan (also called transient elastography) is like an ultrasound. A probe on your skin measures how stiff your liver is. Stiffer means more scarring. It does not hurt. The ELF test is a special blood test that does the same job.
In Ontario, a FibroScan at a private clinic may not be covered by OHIP, and some clinics charge a fee. Ask your doctor where to go.
In Kingston, a FibroScan at Kingston Health Sciences Centre (KHSC) is covered when the KHSC GI (stomach and liver) team arranges it. You do not pay for it.
What helps most?
These steps have the best proof. They help your heart as well as your liver.
Lose some weight, if you are above a healthy weight.
| Weight loss | What it does |
|---|---|
| 5% | Lowers liver fat |
| 7 to 10% | Lowers liver inflammation |
| 10% or more | Can help scarring improve |
For example, if you weigh 90 kg (about 200 lb), 7% is about 6 kg (14 lb).
Ask your doctor or a dietitian for help.
Eat a Mediterranean-style diet. Fill up on vegetables, fruit, beans, lentils, whole grains, nuts, fish and olive oil. Cut back on sugary drinks, sweets and highly processed foods. If you enjoy coffee, you don’t need to stop. Studies link it with less liver damage.
Move more. Aim for at least 150 minutes a week of moderate activity, like brisk walking or cycling. Or do 75 minutes of harder activity, like running. Exercise helps your liver even if the scale doesn’t change.
Drink less alcohol, or none. No amount of alcohol is good for your liver. Canada’s guidance says 2 drinks or fewer a week is low risk for most adults. If you have liver scarring, don’t drink at all.
Are there medicines for it?
Lifestyle changes come first for everyone. For some people with MASH and moderate scarring, medicine can help too.
Semaglutide (Wegovy) is a weekly injection. In December 2025, Health Canada approved it, with conditions, for adults with MASH and moderate to advanced scarring, but not cirrhosis. In a large study, MASH cleared up and scarring improved in more people on semaglutide than on a dummy shot. Drug plans may not cover it, so ask about cost.
MASH cleared up
- Semaglutide63 in 100
- Dummy shot34 in 100
Scarring improved
- Semaglutide37 in 100
- Dummy shot22 in 100
800 adults with MASH and moderate to advanced scarring. Both results were clearly better on semaglutide.
Other medicines to know about:
- Resmetirom (Rezdiffra) is a daily pill for MASH. It is approved in the United States and Europe. As of October 2026, it is not approved in Canada.
- Some diabetes medicines also help the liver. If you have diabetes, ask your doctor which ones suit you.
- Statins (cholesterol pills) are safe for people with fatty liver. They lower your risk of heart attack and stroke. Don’t stop them because of your liver unless your doctor tells you to.
Check with your doctor or pharmacist before you take any supplement or herbal product “for the liver.” Some can harm it.
Fatty liver and diabetes
Fatty liver and type 2 diabetes often go together. About 7 in 10 people with type 2 diabetes have MASLD. They are also more likely to have liver scarring.
If you have type 2 diabetes or prediabetes, ask your doctor to check your FIB-4 score every 1 to 2 years.
Sources for this guide
Sources
- Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology 2023;78:1966–1986. PMID 37363821 New names: steatotic liver disease, MASLD (steatosis plus at least 1 of 5 cardiometabolic risk factors), MASH, MetALD. Criteria listed at aasld.org/new-masld-nomenclature.
- Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023;77:1797–1835. PMID 36727674 FIB-4 first (<1.3 low, 1.3–2.67 intermediate, >2.67 high), then elastography (FibroScan) or ELF. Exercise helps independent of weight loss. Abstain from alcohol with fibrosis ≥F2. Heart disease and non-liver cancers are the main causes of death without advanced fibrosis. Statins safe. Screen people with diabetes.
- EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024;81:492–542. PMID 38851997 Weight loss ≥5% for liver fat, 7–10% for inflammation, ≥10% for fibrosis. Mediterranean-style diet, limit ultra-processed food, avoid sugary drinks. >150 min/week moderate or 75 min vigorous activity. No safe protective level of alcohol. Fibrosis stage drives liver outcomes. Resmetirom where approved; GLP-1 drugs safe.
- Kim J, Bajaj HS, Ramji A, Bemeur C, Sebastiani G. Diabetes and metabolic dysfunction-associated steatotic liver disease in adults: Diabetes Canada clinical practice guideline. Can J Diabetes 2025;49:222–236. PMID 40783292 Canadian guidance. MASLD in about 70% of people with type 2 diabetes; FIB-4 every 1–2 years if low; elastography or ELF if 1.3–2.67; refer if ≥2.67.
- Sanyal AJ, Newsome PN, Kliers I, et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis (ESSENCE). N Engl J Med 2025;392:2089–2099. PMID 40305708 MASH resolution without worse fibrosis 62.9% vs 34.3%; fibrosis improvement 36.8% vs 22.4% at 72 weeks.
- Health Canada. Notice of Compliance with conditions: Wegovy (semaglutide) for non-cirrhotic MASH with moderate to advanced fibrosis (F2–F3), 10 December 2025. Checked 11 October 2026. Resmetirom (Rezdiffra) has no Health Canada approval: no Notice of Compliance for resmetirom in the NOC database (current to NOCs dated 8 October 2026) and no product in the Drug Product Database.
- European Medicines Agency. Rezdiffra (resmetirom): EPAR. Conditional EU marketing authorisation 18 August 2025 for adults with non-cirrhotic MASH and F2–F3 fibrosis, with diet and exercise. (US FDA accelerated approval March 2024.)
- Liver Canada (formerly the Canadian Liver Foundation). Metabolic dysfunction-associated steatotic liver disease (MASLD). Patient handout, October 2025. MASLD affects about 25% of Canadian adults; about 1 in 4 people with MASLD may develop MASH; can be reversed in early stages.
- Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015;149:389–397. PMID 25935633 Fibrosis stage predicts outcomes; 26 of 619 patients (4.2%) had a liver-related event over a median 12.6 years.
- Canadian Centre on Substance Use and Addiction. Canada's Guidance on Alcohol and Health. 2023. 2 standard drinks or less per week: likely to avoid alcohol-related harm; less is better.
- Kingston Health Sciences Centre gastroenterology group (Dr. E. Squirell). Local practice, October 2026. FibroScan at KHSC is covered when it is arranged by the KHSC GI group.
This guide is for general education. It can't replace advice from your own care team, who know your health history.