Metabolic dysfunction-associated steatotic liver disease, or MASLD, affects more than 30% of people worldwide and has become one of the most common forms of chronic liver disease. The main goal of treatment is to slow down disease progression, reduce fat accumulation in the liver, and improve overall health through lifestyle changes, while research continues into new medications that might help patients who need more than lifestyle interventions alone.

How Treatment Helps People Living with MASLD

When you receive a diagnosis of metabolic dysfunction-associated steatotic liver disease, it means that fat has built up in your liver beyond normal levels, typically more than 5 to 10 percent of the liver’s total weight. The good news is that with early detection and proper treatment, this condition can often be slowed down, stopped, or even reversed.^[1] Treatment goals focus on reducing the fat stored in liver cells, preventing inflammation that could lead to more serious liver damage, and addressing the underlying metabolic problems that caused the condition in the first place.^[3]

The approach to treating MASLD depends on several factors, including how much liver damage has already occurred, whether the person has progressed to a more serious form called MASH (metabolic dysfunction-associated steatohepatitis), and what other health conditions are present. MASH involves inflammation and damage to liver cells, which can lead to scarring called fibrosis.^[4] Without treatment, MASLD can progress through different stages, potentially leading to severe scarring called cirrhosis, liver failure, or even liver cancer.^[1]

Treatment is personalized to each patient’s situation. For most people, lifestyle changes form the foundation of care. However, some patients may need additional support from medications or, in severe cases, surgical interventions. Medical societies and healthcare professionals follow established guidelines that recommend starting with the safest and most effective approaches first.^[8] At the same time, researchers are actively testing new therapies in clinical trials to find better treatment options for patients who need more than lifestyle changes alone.^[10]

Standard Treatment Approaches for MASLD

The cornerstone of treating metabolic dysfunction-associated steatotic liver disease is making changes to daily habits and behaviors. Research consistently shows that losing weight, eating a healthier diet, and becoming more physically active can reduce the amount of fat in the liver and, in many cases, reverse the condition completely.^[3] These lifestyle interventions work by addressing the root causes of the disease, which are closely linked to obesity, type 2 diabetes, high cholesterol, and other metabolic problems.^[5]

Weight Loss as Primary Treatment

For most people with MASLD, weight loss is the main treatment strategy. Studies have demonstrated that losing between 7 and 10 percent of total body weight can significantly reduce liver fat and improve MASLD symptoms, as well as overall quality of life.^[13] Even modest weight loss of 3 to 5 percent can start to improve liver health, though greater weight loss brings more substantial benefits.^[3] Weight loss works by reducing the amount of fat stored throughout the body, including in the liver, and by improving how the body responds to insulin.^[16]

The process of losing weight should be gradual and sustainable. Rapid weight loss can sometimes worsen liver inflammation temporarily, so healthcare providers typically recommend steady progress over several months. The goal is not just to lose weight quickly but to maintain healthier habits over the long term.^[18]

Dietary Changes and Nutrition

What you eat plays a fundamental role in managing MASLD. Healthcare professionals recommend eating a well-balanced diet that is low in processed foods, added sugars, and saturated fats. The Mediterranean diet has the strongest evidence for helping people with fatty liver disease.^[11] This eating pattern emphasizes vegetables, fruits, whole grains, legumes (beans, lentils, chickpeas), olive oil, nuts, and seeds. It includes moderate amounts of fish, seafood, eggs, cheese, yogurt, and poultry, while limiting red meat, processed meats like salami and ham, and sweets.^[19]

Reducing sugar intake is particularly important. This includes limiting foods and drinks with added sugars, as well as being mindful of fructose, which is the sugar naturally found in fruit. While fruit provides important vitamins and fiber, people with MASLD are often advised to limit fruit to a maximum of two pieces per day because fructose can increase liver fat.^[19] Avoiding sugary beverages like soft drinks and fruit juices is especially important.^[18]

Creating an energy deficit through diet—meaning consuming fewer calories than the body uses—supports weight loss and liver fat reduction. However, extreme calorie restriction is not recommended because it can be difficult to sustain and may lack important nutrients. Instead, focus should be on eating nutritious foods in appropriate portions.^[8]

Physical Activity and Exercise

Regular physical activity is another essential part of treating MASLD. Exercise helps reduce liver fat even when weight loss doesn’t occur, and it provides additional benefits for heart health, blood sugar control, and overall wellbeing.^[3] The strongest evidence supports aerobic exercise, which includes activities like brisk walking, jogging, cycling, or swimming that get your heart rate up and make you breathe harder.^[18]

Healthcare providers typically recommend at least 150 to 240 minutes of moderate-intensity aerobic exercise per week.^[18] This could be broken down into 30 to 40 minutes of exercise on most days of the week. Moderate intensity means you’re working hard enough that you can talk but not sing during the activity. The exercise doesn’t have to be done all at once—three 10-minute sessions can be just as effective as one 30-minute session.^[13]

Resistance training, also called strength training, involves exercises that make muscles work against a weight or force. This type of exercise is also recommended for people with MASLD, particularly when combined with aerobic exercise. Resistance training helps build and maintain muscle mass, which is important because losing muscle along with fat can be harmful, especially in people who are already frail or have muscle loss called sarcopenia.^[18]

Reducing sedentary behavior—the time spent sitting or lying down while awake—is also important. This means taking breaks from prolonged sitting, whether at work, while watching television, or during other activities. Even small increases in movement throughout the day can make a difference.^[18]

Managing Related Health Conditions

Because MASLD is closely linked to metabolic problems, treating related conditions like type 2 diabetes, high blood pressure, and high cholesterol is an important part of overall care. When these conditions are well managed, it can help improve liver health as well.^[8] Healthcare providers may prescribe medications to control blood sugar, blood pressure, or cholesterol levels. Some medications used for diabetes, particularly certain types, may also have beneficial effects on the liver.^[4]

Bariatric Surgery for Severe Obesity

For people with severe obesity who have not achieved sufficient weight loss through lifestyle changes alone, bariatric surgery (weight loss surgery) may be considered. This type of surgery changes the digestive system to help with weight loss. Studies have shown that bariatric surgery can lead to significant improvements in liver fat, inflammation, and even fibrosis in people with MASLD.^[8] However, surgery carries risks and is reserved for carefully selected patients after thorough discussion with their healthcare team.^[8]

Medications Currently Used

Until recently, there were no medications specifically approved to treat MASLD or MASH. However, the U.S. Food and Drug Administration (FDA) approved a medication called resmetirom for treating MASH with moderate to severe liver fibrosis (stages F2 to F3).^[10] This represents an important milestone as the first medication specifically approved for this condition. Resmetirom works differently than lifestyle interventions, targeting specific receptors in the liver to help reduce fat and inflammation.^[4]

The decision to use resmetirom or similar medications depends on the severity of liver disease and whether lifestyle changes have been sufficient. Not every person with MASLD needs medication, and for many, lifestyle changes remain the most effective treatment. Medications are typically considered for patients with more advanced disease who have not achieved adequate improvement with lifestyle interventions alone.^[10]

New Treatments Being Studied in Clinical Trials

Researchers worldwide are working hard to develop new treatments for MASLD and MASH. Currently, more than 50 active clinical trials are testing different approaches to treating this condition.^[11] These studies are exploring medications that work in various ways, targeting the metabolic problems that cause fat to build up in the liver, as well as the inflammation and scarring that develop in more advanced disease.^[8]

Understanding Clinical Trial Phases

Clinical trials happen in several stages, each designed to answer specific questions about a new treatment. Phase I trials are small studies that test whether a new treatment is safe for humans and help determine the right dose. These studies typically involve a small number of healthy volunteers or patients.^[8]

Phase II trials involve more patients and focus on whether the treatment actually works—whether it reduces liver fat, decreases inflammation, or improves fibrosis. These studies also continue to monitor safety. If a treatment shows promise in Phase II, it moves to Phase III.^[8]

Phase III trials are large studies that compare the new treatment to current standard treatments or placebo (an inactive substance). These studies provide the strongest evidence about whether a treatment works and is safe enough to be approved by regulatory agencies like the FDA in the United States or the European Medicines Agency in Europe.^[8]

Different Types of Treatments Being Tested

The drugs being studied in clinical trials target different parts of the disease process. Some aim to improve how the body processes fats and sugars, addressing the metabolic dysfunction that leads to fat accumulation in the liver. Others target the inflammatory pathways that cause liver cells to become inflamed and damaged. Still others focus on preventing or reversing fibrosis—the scarring that develops as the liver tries to heal itself.^[8]

Many of the investigational treatments work on specific molecular targets. For example, some drugs affect receptors in the liver that control fat metabolism. Others block inflammatory signals or target the cells responsible for creating scar tissue. Because MASLD and MASH are complex diseases with multiple contributing factors, researchers are also studying combination therapies that use more than one drug to address different aspects of the disease simultaneously.^[8]

Promising Results from Recent Studies

Some clinical trials have reported encouraging preliminary results. Certain investigational treatments have shown the ability to significantly reduce liver fat content, decrease markers of inflammation in blood tests, and even reduce fibrosis scores when measured through liver biopsy or non-invasive tests.^[10] However, it’s important to remember that results from clinical trials are preliminary until the studies are completed and the treatments are thoroughly evaluated by regulatory authorities.^[10]

The approval of resmetirom has demonstrated that it is possible to develop effective medications for MASH. The clinical trials for this drug showed that it could improve liver inflammation and reduce fibrosis in patients with MASH and moderate to severe fibrosis. The ongoing clinical trial will continue to collect data about the drug’s long-term effects over the next couple of years.^[10]

Who Can Participate in Clinical Trials

Clinical trials have specific requirements about who can participate, called eligibility criteria. These criteria ensure that the trial safely tests the treatment in the right group of patients. Common requirements include having MASLD or MASH confirmed by imaging or biopsy, having a certain level of liver fibrosis, and not having other liver diseases that could affect the results. Some trials also have requirements about age, weight, and the presence of other health conditions.^[8]

Clinical trials for MASLD and MASH are being conducted in many locations around the world, including the United States, European countries, and other regions. Patients interested in participating can discuss this option with their healthcare provider, who can help determine if any ongoing trials might be appropriate for their situation.^[8]

Future Directions in MASLD Treatment

Researchers are exploring innovative approaches beyond traditional medications. These include investigating whether specific supplements, probiotics, or other nutritional interventions might help improve liver health. Scientists are also studying the role of the gut microbiome—the community of bacteria and other microorganisms living in the digestive system—in MASLD, as there appears to be a connection between gut health and liver disease.^[8]

Another area of research involves developing better non-invasive tests to monitor liver disease. Currently, the most accurate way to assess liver inflammation and fibrosis is through liver biopsy, which involves inserting a needle into the liver to collect a small tissue sample. This procedure carries some risks and can be uncomfortable. Researchers are working on blood tests, imaging techniques, and other non-invasive methods that could provide similar information without needing a biopsy.^[4]

Most common treatment methods

• Lifestyle interventions
  • Weight loss of 7 to 10 percent of body weight through caloric restriction and improved diet quality
  • Mediterranean diet emphasizing vegetables, fruits, whole grains, legumes, olive oil, nuts and fish
  • Reduction of processed foods, added sugars, and foods high in fructose
  • 150 to 240 minutes of moderate-intensity aerobic exercise per week
  • Resistance training to build and maintain muscle mass
  • Reduction of sedentary behavior and prolonged sitting
• Management of metabolic conditions
  • Treatment of type 2 diabetes with appropriate medications
  • Control of high blood pressure
  • Management of high cholesterol and triglycerides
  • Addressing insulin resistance
• Pharmacological treatment
  • Resmetirom for MASH with moderate to severe fibrosis (stages F2 to F3), approved by FDA
  • Medications for associated conditions like diabetes that may also benefit the liver
• Surgical interventions
  • Bariatric surgery for carefully selected patients with severe obesity who have not responded to lifestyle interventions
  • Liver transplantation for end-stage liver disease or liver failure in severe cases
• Experimental treatments in clinical trials
  • Drugs targeting fat metabolism and metabolic dysfunction
  • Anti-inflammatory medications to reduce liver inflammation
  • Anti-fibrotic agents to prevent or reverse liver scarring
  • Combination therapies addressing multiple disease pathways