MASH (Fatty Liver with Inflammation)

It is closely linked to insulin resistance (the body responding poorly to insulin), excess weight especially around the waist, type 2 diabetes, high blood pressure and abnormal blood fats. A diet high in sugary drinks and refined foods and low physical activity contribute. Genes also play a role, which is why some people are affected despite a healthy weight.

Fatty liver is one of the most common liver conditions in the world, and it is increasing along with obesity and type 2 diabetes. Only a portion of people with fatty liver have MASH, and only some of them develop advanced scarring. Many are unaware because there are often no symptoms.

Sugary drinks, sweets and large portions at gatherings and during Ramadan evenings can add up. Choosing water, lean protein, vegetables and smaller portions of dates and desserts helps. If you have diabetes and plan to fast, discuss it with your doctor beforehand.

Fatty liver is often found on ultrasound or from abnormal liver blood tests. The doctor rules out other causes, such as alcohol and viral hepatitis. Then the aim is to estimate scarring using blood-based scores and FibroScan (a painless stiffness test). A liver biopsy, taking a tiny sample, is the most direct way to confirm MASH and is used when other tests are unclear. Blood sugar and cholesterol are also checked.

Lifestyle change is the foundation of treatment.

• Gradual, steady weight loss; a modest loss already helps, and more helps more

• Regular physical activity, including walking and some strength exercises, as your doctor allows

• Avoid alcohol or keep it to what your doctor advises

• Stop smoking

• Sleep well and manage stress

Avoid crash diets and very rapid weight loss, which can worsen liver inflammation.

A Mediterranean-style way of eating is well supported.

• Eat more vegetables, fruit, legumes, whole grains, fish and nuts

• Use olive oil in place of butter or ghee where possible

• Avoid sugary drinks, juices and sweets, including sweet desserts and dates in large amounts

• Limit processed meat, fried food and refined white flour

• Coffee in moderation may be beneficial; ask your doctor

Treatment of MASH also means treating diabetes, blood pressure and cholesterol. Your doctor decides which medicines suit you.

• Some diabetes medicines may also benefit the liver; your doctor will choose for you

• Newer medicines for MASH with moderate to advanced scarring may be available; ask your specialist

• Statins for cholesterol are generally considered safe in fatty liver, as your doctor advises

• Do not use herbal "liver cleanse" products or supplements without asking

Procedures are for selected patients.

• Bariatric (weight-loss) surgery or endoscopic weight-loss procedures for suitable people with severe obesity

• Liver biopsy or FibroScan to stage scarring

• Ultrasound surveillance for liver cancer and endoscopy for veins if cirrhosis develops

• Liver transplant in end-stage disease

Research on MASH is active. Weight loss, particularly when sustained, improves liver inflammation and can reduce scarring. Some medicines are now being approved or studied for MASH with scarring; ask your specialist what is suitable for you.

Many people never develop serious liver disease, but those with significant scarring need closer follow-up. Heart disease is also a major risk in people with MASH, so protecting the heart and treating diabetes and blood pressure are part of care. Lifestyle changes can improve or even reverse liver changes.

• How much scarring do I have?

• What weight-loss goal is realistic for me?

• Do I need a biopsy or FibroScan?

• Are there medicines for MASH that suit me?

• How often should my liver be checked?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.