Has your doctor mentioned "hepatic steatosis", "fatty liver" or "NAFLD" after a blood test or an ultrasound? You share this situation with almost one adult in three worldwide. The 2024 European guidelines put the prevalence of this condition at more than 30% of the general population, up from 25% in 2016. It usually causes no symptoms for years.
Metabolic fatty liver has a feature that is rare in medicine: it goes into reverse. Moderate weight loss, a Mediterranean-inspired plate and regular physical activity reduce liver fat, then inflammation, and in some patients fibrosis itself. Since 2024, two medicines have also been authorised for the forms with fibrosis. This guide brings together the 2024 EASL-EASD-EASO guidelines and the clinical trials published up to October 2026.
Our promise at Diaeta: personalised, evidence-based support, without hunger and with foods you find tasty. Reversing fatty liver does not mean joyless meals. It means eating better, in a way you can keep up.
1. The Key Facts in 8 Points
- Since 2023, NAFLD has been called MASLD (metabolic dysfunction-associated steatotic liver disease). NASH has become MASH. A new category, MetALD, describes people who combine a metabolic profile with moderate to high alcohol intake.
- Insulin resistance is the main driver. A large waist, prediabetes, type 2 diabetes, high triglycerides and high blood pressure are its signs.
- Cardiovascular risk rises with MASLD. Your heart deserves as much attention as your liver.
- Fibrosis determines the outlook. A simple calculation from your blood test, the FIB-4 score, lets your doctor sort cases by risk.
- Losing 5% of your body weight reduces liver fat. Losing 7 to 10% improves inflammation. Losing 10% or more can improve fibrosis.
- The Mediterranean eating pattern reduced liver fat even without weight loss in a six-week trial.
- Physical activity reduces liver fat independently of weight loss, from about 150 minutes of brisk walking a week.
- Two medicines are authorised in the European Union for MASH with moderate to advanced fibrosis: resmetirom (2025) and semaglutide (2026). They add to nutrition and physical activity; they do not replace them.
2. Fatty Liver: From NAFLD to MASLD
Hepatic steatosis means a build-up of fat (triglycerides) inside liver cells. In everyday language, people call it "fatty liver". In medical practice, doctors speak of steatosis when more than 5% of liver cells contain fat droplets.
2.1 Why Change the Name in 2023?
For decades, doctors used the term NAFLD (non-alcoholic fatty liver disease). The name had two problems. It defined the condition by what it is not ("non-alcoholic") rather than by its cause. And many patients found the word "fatty" stigmatising.
In June 2023, the American (AASLD), European (EASL) and Latin American (ALEH) liver societies published a new nomenclature, built through a Delphi consensus involving 236 experts from 56 countries. Of these, 74% judged the old terminology flawed enough to change it.
| Old term | New term | What it describes |
|---|---|---|
| Hepatic steatosis (umbrella term) | SLD (steatotic liver disease) | Any build-up of fat in the liver, whatever the cause |
| NAFLD | MASLD | Steatosis + at least one cardiometabolic risk factor, without significant alcohol intake |
| NASH | MASH | The inflammatory form of MASLD, with liver cell injury |
| No equivalent | MetALD | MASLD + alcohol intake of 20 to 50 g/day in women, 30 to 60 g/day in men |
| Alcohol-related liver disease | ALD | Steatosis linked to alcohol intake above these thresholds |
Hepatologists in Belgium and elsewhere now use the acronym MASLD. If your ultrasound report mentions "steatosis" and your doctor talks about "metabolic" fatty liver, it is the same condition.
2.2 The Five Cardiometabolic Criteria
A diagnosis of MASLD requires steatosis plus at least one of the following criteria (European values):
| Criterion | Threshold |
|---|---|
| Weight or waist size | BMI ≥ 25 kg/m² or waist circumference ≥ 94 cm (men), ≥ 80 cm (women) |
| Blood sugar | Fasting glucose ≥ 100 mg/dL (5.6 mmol/L), HbA1c ≥ 5.7%, type 2 diabetes or diabetes treatment |
| Blood pressure | ≥ 130/85 mmHg or antihypertensive treatment |
| Triglycerides | ≥ 150 mg/dL (1.7 mmol/L) or lipid-lowering treatment |
| HDL cholesterol | ≤ 40 mg/dL (1.0 mmol/L) in men, ≤ 50 mg/dL (1.3 mmol/L) in women |
Key insight: The new definition puts metabolism at the centre. Steatosis with a large waist or borderline blood sugar is no longer an "ultrasound finding": it signals insulin resistance that affects the liver, muscles, blood vessels and pancreas.
2.3 From Steatosis to Cirrhosis
MASLD progresses in stages, and each one can stay stable or reverse:
- Simple steatosis: fat without notable inflammation. This is the most common form.
- MASH: the fat comes with inflammation and damaged ("ballooned") cells.
- Fibrosis: the liver heals by laying down scar tissue, graded from F0 (none) to F4 (cirrhosis).
- Cirrhosis: fibrosis disrupts the structure of the liver. The risk of complications and liver cancer rises.
3. Who Is Affected?
3.1 Insulin Resistance at the Core
When your cells respond poorly to insulin, fat tissue releases more fatty acids into the blood, and the liver takes up a large share of them. At the same time, excess insulin pushes the liver to make its own fat from sugars, a process called de novo lipogenesis. The liver stores more fat than it exports or burns.
This mechanism explains why steatosis so often goes hand in hand with prediabetes. Our article on the continuum from insulin resistance to type 2 diabetes describes these stages in detail.
3.2 The Most Exposed Profiles
- Large waist: deep abdominal (visceral) fat drains straight into the liver's circulation.
- Type 2 diabetes: a global meta-analysis of 80 studies estimates that about 55% of people with type 2 diabetes have metabolic fatty liver, and 37% an inflammatory form (NASH). The European guidelines advise screening for fibrosis in people with type 2 diabetes.
- Dyslipidaemia: high triglycerides and low HDL form the typical lipid profile of insulin resistance.
- High blood pressure.
- Sleep apnoea, polycystic ovary syndrome: two conditions linked to insulin resistance.
A normal weight does not give full protection. A person with a BMI of 23 but borderline blood sugar and a growing waistline can meet the criteria for MASLD.
3.3 The Liver and the Heart
A meta-analysis of 36 longitudinal studies, covering more than 5.8 million people followed for 6.5 years on average, links metabolic fatty liver to a higher risk of fatal and non-fatal cardiovascular events. This risk rises with the severity of the liver disease, in particular when fibrosis is present.
For most patients, protecting the liver also means protecting the arteries. The European guidelines state that statins can be used safely in people with MASLD when their cardiovascular risk calls for it. Our complete cholesterol guide covers the lipid side of this assessment.
4. How Your Doctor Makes the Diagnosis
4.1 Liver Enzymes: Useful but Misleading
Transaminases (ALT and AST) and gamma-GT appear on most blood tests. Raised values point to liver stress. But normal transaminases rule out neither steatosis nor fibrosis. That is why the guidelines go beyond this test.
4.2 Ultrasound
An abdominal ultrasound shows a "brighter" (hyperechoic) liver when fat builds up. It is easy to access and involves no radiation, but it misses mild steatosis and does not measure fibrosis.
4.3 The FIB-4 Score: A Simple Calculation, a Key Step
The FIB-4 combines four values your GP already has: your age, AST, ALT and platelet count. It estimates the probability of advanced fibrosis.
| FIB-4 result | Interpretation | Usual next step |
|---|---|---|
| < 1.3 (< 2.0 over age 65) | Advanced fibrosis unlikely | Lifestyle and risk factor care, periodic reassessment |
| Between 1.3 and 2.67 | Intermediate zone | Second test: liver stiffness measurement |
| ≥ 2.67 | Advanced fibrosis possible | Referral to a hepatologist or gastroenterologist |
4.4 Elastography: Measuring Liver Stiffness
Transient elastography sends a mechanical wave through the liver and measures how fast it travels. A fibrotic liver is stiffer, and the wave moves through it faster. The test takes a few minutes and is painless. The same device can also estimate the amount of fat.
- Below 8 kPa: advanced fibrosis unlikely.
- 12 kPa or more: advanced fibrosis likely, specialist referral.
- In between: grey zone, to discuss with your hepatologist.
Liver biopsy remains the reference test, but it is no longer needed in the vast majority of cases. Your hepatologist reserves it for situations where the diagnosis remains uncertain.
In practice in Belgium: if you have type 2 diabetes, a large waist or several risk factors, ask your GP whether your FIB-4 has been calculated. The score comes from a routine blood test.
5. Weight Loss: The Thresholds That Matter
For people living with excess weight, weight loss remains the best-documented lever. The 2024 European guidelines set three tiers, sustained over time:
| Lasting weight loss | Expected effect on the liver | Example for 90 kg |
|---|---|---|
| ≥ 5% | Less liver fat | 4.5 kg |
| 7 to 10% | Improvement in inflammation (MASH) | 6.3 to 9 kg |
| ≥ 10% | Possible improvement in fibrosis | 9 kg or more |
5.1 The Study Behind These Benchmarks
These thresholds come largely from a Cuban study published in 2015 in Gastroenterology. The researchers followed 293 adults with NASH through a year of lifestyle change, with a liver biopsy at the start and at the end:
- Among participants who lost at least 5% of their weight, 58% saw their NASH resolve.
- Among those who lost at least 10%, 90% saw their NASH resolve, all improved their activity score and 45% saw their fibrosis regress.
- Across the whole group, only about 30% reached 5% weight loss.
That last figure matters as much as the others. Liver biology responds well to weight loss. The hard part lies in how to get there and how to stay there. An approach that leaves you hungry rarely lasts more than a few months: our article on why conventional weight-loss plans fail explains why.
Key insight: Your liver does not need an "ideal" weight. It responds to a percentage. For a person weighing 100 kg, 5 kg already changes the amount of fat in the liver, and 10 kg opens the door to an improvement in fibrosis.
5.2 What If You Don't Lose Weight?
Weight is not the only lever. What you put on your plate (section 6) and physical activity (section 9) reduce liver fat even when the scales barely move. These effects add to those of weight loss.
6. Fat on the Liver: What Should You Eat?
You may have searched for "fatty liver diet" or "what to eat with fat on the liver". No food "cleanses" the liver. One eating pattern, however, has proven itself: the Mediterranean pattern. The European guidelines draw on prospective studies that link this way of eating to a lower risk of MASLD.
6.1 A Landmark Trial: Less Liver Fat Without Weight Loss
In 2013, an Australian team compared two eating plans for six weeks in 12 people with biopsy-proven steatosis, each person trying both. The Mediterranean plan reduced liver fat by 39% in relative terms, against 7% for a low-fat, high-carbohydrate plan. Insulin sensitivity improved with the Mediterranean plan only. Body weight did not change. The trial is small, but it shows that the quality of what you eat acts on the liver beyond calories.
6.2 What to Put on Your Plate More Often
| Food | Why it helps your liver | Practical ideas |
|---|---|---|
| Vegetables (at every meal) | Fibre, volume and fullness for few calories | Homemade vegetable soup, pan-fried Belgian endive, a raw vegetable salad as a starter |
| Pulses | Fibre and plant protein, steady blood sugar | Red lentil dahl, roasted chickpeas, hummus, kidney bean chilli |
| Whole grains | Fibre that slows carbohydrate absorption | Wholemeal sourdough bread, oat flakes, bulgur, brown rice |
| Olive oil | Monounsaturated fats in place of saturated fats | For dressings and gentle cooking, in place of butter |
| Oily fish (twice a week) | Long-chain omega-3 fatty acids | Mackerel, sardines, salmon, herring |
| Nuts and seeds | Unsaturated fats, fibre, filling effect | A small handful of walnuts, almonds or hazelnuts as a snack |
| Whole fruit | Fibre, water and polyphenols | Apple, pear, berries, citrus fruit |
| Poultry, eggs, plain dairy | Protein that fills you up and preserves muscle | Plain yoghurt, quark, vegetable omelette |
6.3 Fibre and Satiety: Your Best Ally
Fibre, protein and the volume of vegetables trigger the satiety hormones. That is what lets you eat fewer calories without feeling hungry. Our article on the science of satiety shows how to build meals that keep you full for several hours.
6.4 Red Meat and Processed Meat
The European guidelines note a dose-dependent association between eating red meat, processed or not, and the risk of MASLD. In practice, rotate: fish, poultry, eggs and pulses can fill most of your meals, while red meat keeps its place as a dish you savour.
7. Added Sugars, Fructose and Sugary Drinks
7.1 Why Fructose Concerns the Liver
Glucose circulates throughout the body. Fructose, by contrast, is taken up largely by the liver. In excess, the liver turns part of it into fat through de novo lipogenesis. Table sugar (sucrose) is half glucose and half fructose, just like the glucose-fructose syrup in industrial soft drinks.
7.2 Sugary Drinks on the Front Line
The European guidelines link sugary drinks to the risk of developing MASLD, with a dose-dependent effect. A 330 ml can of soft drink provides about 35 g of sugar, absorbed within minutes, with no fibre and no fullness.
Whole fruit plays in a different league. It provides little fructose per portion, together with fibre and water that slow its absorption and fill you up. Fruit juices, even "100% pure juice", sit closer to soft drinks.
7.3 What to Drink Instead
- Water, still or sparkling, flavoured at home with lemon, mint or cucumber slices.
- Tea and coffee without added sugar (see section 8).
- Sweetened drinks as a transition step: in a meta-analysis of randomised trials, replacing sugary drinks with low- or no-calorie versions went with lower body weight and less liver fat. Our scientific guide to sweeteners helps you choose.
Key insight: If you drink sugary drinks every day, replacing them is often the simplest and most rewarding change for your liver. It asks nothing of you at the table.
8. Alcohol, Coffee and Ultra-Processed Foods
8.1 Alcohol: Understanding the MetALD Category
Alcohol and metabolism act on the liver together. The new nomenclature reflects this: a person with metabolic fatty liver who drinks 20 to 50 g of alcohol a day (women) or 30 to 60 g a day (men) falls into the MetALD category. In Belgium, a standard drink contains 10 g of alcohol: this equals about 2 to 5 drinks a day for a woman and 3 to 6 for a man.
The European guidelines discourage alcohol for everyone with steatosis, in particular when intake is moderate or high. With advanced fibrosis or cirrhosis, they recommend stopping completely and for good.
If you enjoy a glass of wine with your meal, talk about it openly with your doctor and your dietitian. Together, we look for alternatives you enjoy: alcohol-free beers, homemade mocktails, sparkling water with citrus, low-sugar kombucha.
8.2 Coffee: Good News
Coffee is one of the few habits linked to a healthier liver. A meta-analysis of 11 observational studies (2021) associates coffee drinking with a lower risk of steatosis (relative risk 0.77) and, in people who already have it, a lower risk of significant fibrosis (relative risk 0.68). The European guidelines echo this finding, while pointing out that it comes from observational studies.
If you like coffee, you can keep it. Choose it unsweetened or lightly sweetened, and without flavoured syrup. If coffee keeps you awake or gives you palpitations, nothing obliges you to drink it.
8.3 Ultra-Processed Foods
A 2023 meta-analysis based on the NOVA classification links a high intake of ultra-processed foods to a higher risk of steatosis. The European guidelines cite the abundant supply of cheap, sugary ultra-processed products as a factor that promotes obesity and MASLD.
These products often combine added sugars, refined fats and little ability to fill you up. You don't need to cook like a chef to eat fewer of them: plain yoghurt with fruit, frozen vegetables stir-fried with an egg, or a tin of rinsed chickpeas in a salad will do.
9. Physical Activity: An Effect Beyond Weight
Exercise acts on the liver in two ways. It improves insulin sensitivity in the muscles, which then take up more glucose. And it uses fat as fuel, including fat that comes from the liver.
9.1 What the Trials Show
A meta-analysis of 14 randomised trials (551 participants), published in 2023 in the American Journal of Gastroenterology, measured liver fat by MRI:
- Participants on an exercise programme were 3.5 times more likely to achieve a relative drop of at least 30% in liver fat.
- This effect appeared from about 750 MET-minutes per week, roughly 150 minutes of brisk walking.
- It occurred independently of clinically significant weight loss.
The trials covered endurance training, interval training, strength training and combinations of these. The European guidelines advise more than 150 minutes a week of moderate activity or 75 minutes of vigorous activity, tailored to your preferences and abilities.
9.2 Endurance and Strength: Both Count
- Endurance: brisk walking, cycling, swimming, dancing. You should be able to talk, but not sing.
- Strength training: bodyweight exercises, resistance bands, gym machines, twice a week. Muscle is the body's largest consumer of glucose, and preserving it matters all the more if you lose weight, in particular on GLP-1 treatment.
- Moving after meals: 10 to 15 minutes of walking after a meal lowers the blood sugar spike. Find out how in our article on the post-meal walk.
Key insight: Even if the scales don't move, every week of brisk walking works for your liver. Physical activity is not a "calorie expense" to make up for: it is a treatment for steatosis in its own right.
10. Medicines: Resmetirom, Semaglutide and GLP-1
Until 2024, no medicine had a specific authorisation for MASH. That has changed. These treatments concern patients with MASH and moderate to advanced fibrosis (stages F2 to F3), without cirrhosis. Prescribing them is a matter for your hepatologist or doctor, never a decision to make alone.
10.1 Resmetirom
Resmetirom acts on a thyroid hormone receptor found in the liver (the THR-β receptor) and stimulates fat burning in liver cells.
- MAESTRO-NASH trial (New England Journal of Medicine, 2024): after 52 weeks, NASH resolved without worsening of fibrosis in 25.9% (80 mg) and 29.9% (100 mg) of patients, against 9.7% on placebo. Fibrosis improved by at least one stage in 24.2% and 25.9% of patients, against 14.2% on placebo.
- United States: accelerated approval by the FDA in March 2024.
- European Union: conditional marketing authorisation from the European Commission in August 2025, for adults with non-cirrhotic MASH and moderate to advanced fibrosis, alongside nutrition and physical activity.
The 2024 EASL-EASD-EASO guidelines suggest considering resmetirom in adults with non-cirrhotic MASH and significant fibrosis (stage 2 or above).
10.2 Semaglutide
Semaglutide is a GLP-1 receptor agonist, already used in type 2 diabetes and obesity.
- ESSENCE trial (New England Journal of Medicine, 2025): in 800 adults with MASH and F2 or F3 fibrosis, semaglutide 2.4 mg weekly resolved inflammation without worsening fibrosis in 62.9% of patients, against 34.3% on placebo, after 72 weeks. Fibrosis improved without worsening of MASH in 36.8% of patients, against 22.4% on placebo.
- United States: accelerated approval of Wegovy for MASH with moderate to advanced fibrosis in August 2025.
- European Union: semaglutide received conditional authorisation on 26 March 2026 for this indication, under the brand name Kayshild, alongside nutrition and physical activity.
Both European authorisations are conditional: the manufacturers must still provide long-term results from ongoing trials, in particular on liver complications. Reimbursement conditions in Belgium fall under INAMI and may change. Your hepatologist will tell you what applies to your situation.
10.3 GLP-1 Medicines in People With Diabetes or Excess Weight
Apart from the MASH indication, the European guidelines advise using incretin-based treatments (semaglutide, tirzepatide) when they are indicated for type 2 diabetes or obesity. For a person with both fatty liver and diabetes, this choice serves both conditions.
These medicines reduce appetite. Your nutrition then plays a central role: getting enough protein to preserve your muscle mass, managing nausea, and preventing deficiencies as portions shrink. Our guide to GLP-1 treatments and our GLP-1 support describe this care in detail.
10.4 Bariatric Surgery
The European guidelines cite bariatric surgery as an option for people with MASLD and obesity, according to the usual criteria. This decision is made with a multidisciplinary team.
Important: Never start, stop or change a treatment without talking to your doctor. MASH medicines add to nutrition and physical activity, which remain the foundation of every guideline.
11. A Realistic Timeline
The liver responds fast to some changes and more slowly to others. Here is what the studies suggest you can expect:
| Period | What happens | Source |
|---|---|---|
| First weeks | Liver fat starts to fall with a Mediterranean eating pattern, even without weight loss | 6-week crossover trial (2013) |
| 2 to 6 months | With regular activity (about 150 minutes a week), a measurable drop in liver fat; first kilos lost | Exercise trials of 4 to 52 weeks (2023 meta-analysis) |
| 12 months | With 7 to 10% weight loss, improvement in inflammation; beyond 10%, possible regression of fibrosis | 52-week study with biopsies (2015) |
| 18 months and beyond | With added medication, improvements measured at 72 weeks in the ESSENCE trial | ESSENCE (2025) |
Your doctor will track progress with the same tools used for the diagnosis: blood tests, FIB-4 and, if needed, elastography. Fat often recedes before fibrosis does. Don't lose heart if the fibrosis score moves slowly: it reflects scars that remodel over months.
12. Frequently Asked Questions
Is fatty liver reversible?
Yes, in most cases. Liver fat falls from 5% weight loss. Inflammation improves from 7 to 10%. Fibrosis can regress beyond 10%, or with the new medicines in eligible patients. Established cirrhosis is much harder to reverse, which is why acting early pays off.
I have fat on my liver: what should I eat?
Build your meals around vegetables, pulses, whole grains, olive oil, oily fish, nuts and whole fruit. Add a protein source at every meal to stay full. Replace sugary drinks with water, tea or unsweetened coffee. You will find the details in section 6.
Is there such a thing as a "fatty liver diet"?
No specific eating plan melts liver fat away. What works is a Mediterranean-style eating pattern, gradual weight loss if you carry excess weight, and physical activity. Approaches that leave you hungry bring fast weight loss, then the weight comes back. For your liver, how long you keep going matters more than how fast.
Is coffee good for the liver?
Observational studies link coffee drinking to less steatosis and less fibrosis in people who have the condition. These data do not prove cause and effect, but nothing suggests you should give up your coffee. Drink it without added sugar if you can.
Can I drink alcohol with fatty liver?
The European guidelines discourage alcohol for people with steatosis. Above 20 g a day for women and 30 g for men, the condition is called MetALD, a form in which alcohol and metabolism damage the liver together. With advanced fibrosis or cirrhosis, stopping completely is recommended. Discuss your situation with your doctor.
Is fruit bad for the liver because of fructose?
No. Whole fruit provides little fructose per portion, together with fibre and water. The concerns relate to added sugars, sugary drinks and juices. Two to three pieces of fruit a day fit well into a liver-friendly way of eating.
Can you have fatty liver without being overweight?
Yes. MASLD is defined by steatosis plus at least one cardiometabolic criterion: borderline blood sugar, high blood pressure, high triglycerides, low HDL or a large waist. A person of normal weight can therefore be affected. For them too, food quality and physical activity are the main levers.
How long does it take to reverse fatty liver?
Liver fat starts to fall within a few weeks once your eating and activity change. Improvements in inflammation and fibrosis are measured at 12 months or more. The timeline in section 11 sums up these steps.
13. Our Personalised Approach at Diaeta
Fatty liver rarely comes alone. It often goes with prediabetes or type 2 diabetes, high cholesterol or triglycerides, borderline blood pressure, and sometimes GLP-1 treatment. We build a plan that takes all these conditions into account at once, in contact with your GP, your diabetologist or your hepatologist.
What We Promise You
- Never hungry: we build your meals on fibre, protein and the volume of vegetables, the levers that fill you up while reducing liver fat.
- No needless eliminations: your favourite dishes stay on the menu. We adapt them so they serve your liver, with no blacklist.
- Evidence-based advice: our recommendations follow the EASL-EASD-EASO guidelines and recent clinical trials, not passing trends.
- Personalised strategies: your food culture, budget, schedule and tastes shape every suggestion.
How We Support You
- Complete assessment: a review of your eating, your habits, your blood results (transaminases, blood sugar, lipids, FIB-4 when available) and your body composition, to tell fat mass apart from muscle mass.
- A clear, achievable target: together we set a weight loss goal as a percentage, aligned with the 5%, 7 to 10% and 10% thresholds, at a pace you can sustain.
- A Mediterranean plate to your taste: simple recipes, adapted to Belgian cooking as well as to your family traditions.
- Care for multiple conditions: if you also have diabetes or high cholesterol, we coordinate priorities instead of piling up instructions.
- Support during GLP-1 treatment: protein intake, managing digestive side effects, preserving muscle.
Results We See
With our personalised approach, our patients usually report:
- Gradual, lasting weight loss, without feeling hungry, thanks to meals that fill them up.
- Blood results that improve over successive check-ups with their doctor: transaminases, blood sugar, triglycerides.
- More energy day to day, as eating and physical activity settle into a routine.
- A calmer relationship with food, because eating remains a pleasure.
To learn more, explore our weight management support and our complete guide to type 2 diabetes.
Has your doctor found fatty liver, raised transaminases or a FIB-4 score to monitor? Book an appointment with an INAMI-registered dietitian in Brussels. Together, we will build tasty, filling meals that reduce the fat in your liver.
Scientific References
- European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. Also published in Obes Facts. 2024;17(4):374-444. doi:10.1159/000539371.
- Rinella ME, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556. doi:10.1016/j.jhep.2023.06.003.
- Younossi ZM, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019;71(4):793-801.
- Mantovani A, et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(11):903-913. PMID: 34555346.
- Vilar-Gomez E, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378. PMID: 25865049.
- Ryan MC, Itsiopoulos C, Thodis T, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol. 2013;59(1):138-143. PMID: 23485520.
- Stine JG, et al. Exercise training is associated with treatment response in liver fat content by magnetic resonance imaging independent of clinically significant body weight loss in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Am J Gastroenterol. 2023;118(7):1204-1213. PMID: 36705333.
- Hayat U, et al. The effect of coffee consumption on the non-alcoholic fatty liver disease and liver fibrosis: a meta-analysis of 11 epidemiological studies. Ann Hepatol. 2021;20:100254. PMID: 32920163.
- Henney AE, Gillespie CS, Alam U, Hydes TJ, Cuthbertson DJ. Ultra-processed food intake is associated with non-alcoholic fatty liver disease in adults: a systematic review and meta-analysis. Nutrients. 2023;15(10):2266. PMID: 37242149.
- McGlynn ND, et al. Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(3):e222092.
- Harrison SA, et al. A phase 3, randomized, controlled trial of resmetirom in NASH with liver fibrosis. N Engl J Med. 2024;390(6):497-509. PMID: 38324483.
- Sanyal AJ, Newsome PN, et al. Phase 3 trial of semaglutide in metabolic dysfunction-associated steatohepatitis. N Engl J Med. 2025;392(21):2089-2099. PMID: 40305708.
- European Medicines Agency. Rezdiffra (resmetirom): EPAR, conditional marketing authorisation, August 2025.
- European Medicines Agency. Kayshild (semaglutide): EPAR, conditional marketing authorisation, 26 March 2026.
- U.S. Food and Drug Administration. Accelerated approval of Wegovy (semaglutide) for non-cirrhotic MASH with moderate to advanced fibrosis, August 2025.
