The liver disease no one talks about

If you have diabetes, are overweight or have bad lipids, you may have MASLD: metabolic-associated steatotic liver disease – or fatty liver to be brief.

Most of us know that heavy alcohol use is bad for your liver, and years ago, most patients with cirrhosis (advanced liver damage with scarring and loss of function) were alcoholics.

In 2026, with the world-wide epidemic of overweight and obesity. MASLD has become the commonest cause of liver disease that can progress to cirrhosis. Up to 38% of adults have this! If you have Type 2 diabetes, that rises to 65%!

The first stage is fatty infiltration of the liver. If nothing is done, scarring and replacement of functioning liver tissue with fibrous (scar) tissue can follow. Eventually the liver loses much of its function, and the complications of a scarred non-functional liver ensue. These include jaundice, swelling of the legs and abdomen and bleeding.

Untreated MASLD is also the number one cause of liver cancer.

How can you prevent this cascade of catastrophes?

First, if you fit the risk profile (diabetic, overweight and/or high triglycerides), ask your doctor to check your liver. While most doctors know they should check your eyes if you have diabetes, many do not think about the liver.

Standard “liver function tests” are not routinely done and are not always abnormal in early stages of MASLD. While elevated liver enzymes may offer the first clue to the problem, 20-25% of people with biopsy-proven fatty livers have normal liver blood tests.

A better test is the “FIB-4” value, which is calculated from your age, two simple liver enzyme tests and the count of your blood platelets. If this is abnormal, an ultrasound test should be done to look for any scarring.

The good news is that getting your lipids and blood sugar under control and losing weight will reliably reduce fat in the liver and prevent you from going on to worse liver disease.

The GLP-1 drug semaglutide (Wegovy) has been proven to improve MASLD and is FDA-approved for this use. Though not studied for this use, the other GLP-1 agents would probably be equally effective.

You cannot live without your liver, so look after it!


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