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Fatty liver disease means extra fat has built up inside liver cells. Most people have no symptoms; it is usually found by chance on a blood test or a scan done for something else. Doctors now call it MASLD.
The Canadian Digestive Health Foundation explains that in 2023 liver specialists renamed non-alcoholic fatty liver disease, or NAFLD, as metabolic dysfunction-associated steatotic liver disease, shortened to MASLD. Its inflamed form, NASH, became MASH. The old name said what the condition was not; the new one names what it sits alongside.
It is also not a verdict on how anyone has lived. Manitoba’s provincial guideline notes that 10 to 20 percent of people with MASLD show none of the usual metabolic risk factors. For most people the liver holds extra fat and keeps working. In a smaller group it becomes inflamed, and that can leave scar tissue, which is what matters most.
The early stages are silent, so tests usually find MASLD first.
Some risk factors cannot be changed:
Others can often be worked on, usually with support from a health care team:
MASLD is usually picked up in primary care. Manitoba’s provincial guideline starts from a liver enzyme called ALT that stays raised, or fat seen on imaging. Blood tests of liver function, a blood count, HbA1c and fasting lipids follow, with an abdominal ultrasound, while other liver conditions are ruled out. The key step is estimating scarring, using a score called FIB-4 that combines your age, two liver enzymes and your platelet count. A low result usually means care continues in primary care; a higher one leads to referral.
Canadian guidance has no single medicine aimed at the liver itself. Manitoba’s guideline puts everyday measures first, alongside treating the conditions that come with MASLD. A team may discuss:
These are decisions for you and your own clinician.
Most people with MASLD will never develop serious liver disease, and there is no reliable way to tell early on who will. The CMAJ Open modelling study projected compensated cirrhosis rising 95 percent between 2019 and 2030, and annual liver-related deaths doubling. The Institute of Health Economics notes FIB-4 is rarely built into Canadian medical records, so cases go unrecognised. Studies are testing medicines aimed at liver fat, inflammation and scarring, non-invasive tests that could replace biopsy, and ways to find scarring earlier in primary care.
Taking part is voluntary, informed consent comes first, you can stop at any time without affecting your regular care, and no one can say in advance whether a study will help you.
This page is written in plain language for people considering clinical research. It is general health information, not medical advice, and it does not replace a conversation with your own doctor or nurse practitioner.
The Canadian Digestive Health Foundation explains that in 2023, liver disease specialists agreed to rename non-alcoholic fatty liver disease as metabolic dysfunction-associated steatotic liver disease, shortened to MASLD, and to rename its inflamed form NASH as MASH. The old name defined the condition by what it was not. The new one names what it is usually found alongside: the metabolic factors that include body weight, blood sugar, blood lipids and blood pressure. It is the same condition, described more accurately.
For most people, no. Many people with MASLD have fat in the liver without inflammation or scarring, and the liver continues to work. A smaller group develops inflammation, and over years that can leave scar tissue. The Canadian modelling study behind the national estimates projected about 195,000 Canadians with compensated cirrhosis by 2030, out of more than nine million with fatty liver disease. Because there is no reliable way to tell early on who is at risk, Canadian guidance uses a blood-test score called FIB-4 to estimate scarring and decide who needs specialist assessment.
Because the biggest questions are still open: which people will progress to serious liver disease, how to detect scarring early, and whether medicines aimed at the liver itself change the course of the condition. Trials in this area usually involve blood tests, scans and sometimes a liver biopsy, all explained in advance. Taking part is voluntary, you give informed consent before anything begins, and you can withdraw at any time without affecting your regular care.
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