Fatty liver symptoms: what grade 1, 2 and 3 mean, the new name MASLD, and what helps

Told you have fatty liver on a scan, but you feel fine? That's the usual story. Here's what it means, how doctors check whether it matters, and how to reverse it.

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Quick answer

What are the symptoms of fatty liver?

Fatty liver usually causes no symptoms, and most people find out from a scan or blood test done for something else. Some people feel very tired or have a dull ache under the right ribs. Signs such as yellow skin or eyes, a swollen tummy or legs, itching and easy bruising appear only when the liver is badly scarred (cirrhosis).

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Health information, not medical advice. Your doctor knows your full picture; ask them about your result.

Side by side

Early fatty liver vs cirrhosis: how the signs differ

Fatty liver can go through four stages, from fat alone to inflammation, scarring and finally cirrhosis. The early stages are usually silent; symptoms mostly come with cirrhosis. These are the usual differences.

What you noticeFatty liver (early stages)Cirrhosis (late stage)
How you feelUsually nothing; sometimes tired or generally unwellTired and unwell all the time
TummySometimes a dull ache or discomfort under the right ribsPain, or a swollen tummy from fluid
Appetite and weightUsually normal; often extra weight around the waistPoor appetite, weight loss, feeling sick
Skin and eyesNormalYellow skin or eyes, itching, small red spider-like blood vessels, blotchy red palms
Bleeding and bruisingNormalBruising or bleeding easily; vomiting blood or black poo is an emergency
Legs and feetNormalSwollen legs, ankles or feet
ThinkingNormalConfusion, poor concentration, slurred speech
Can it get better?Yes: the fat can go with weight loss and less alcoholThe scarring is permanent, but treatment can stop it getting worse
How it's foundBlood tests and an ultrasound scan, often by chanceBlood tests, scans and a liver specialist's assessment

Inflammation (MASH) and scarring (fibrosis) sit between these two and usually cause no symptoms, so blood tests and scans, not symptoms, show how far it has gone.

Fatty liver symptom checklist

Tick what applies to you. The card shows whether your ticks lean towards early fatty liver and its risk factors, or towards signs of a badly scarred liver. Nothing is saved or sent anywhere.

Fatty liver symptom checklist

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Early signs and risk factors0/10
Signs of advanced liver damage0/6

Tick anything that applies to you.

HbA1c test guide Ask about my symptoms

This checklist sorts symptoms and risks into a pattern for your doctor. It can't diagnose fatty liver or tell how scarred a liver is: that needs blood tests and scans, and early fatty liver usually has no symptoms at all.

What is fatty liver, and why is it now called MASLD?

Fatty liver means fat has built up inside the liver. It's the most common long-term liver condition in the world, affecting more than 30% of people worldwide, and about 24% of adults in the US.

There are two main kinds:

  • Fatty liver linked to weight, blood sugar and blood fats (metabolic). This is the most common kind.
  • Alcohol-related fatty liver, caused mainly by drinking too much alcohol.

New names. In June 2023 the international liver societies changed the names:

  • non-alcoholic fatty liver disease (NAFLD) became metabolic dysfunction-associated steatotic liver disease (MASLD)
  • non-alcoholic steatohepatitis (NASH), the inflamed form, became metabolic dysfunction-associated steatohepatitis (MASH)
  • MetALD is for people who have the metabolic kind and also drink more alcohol

The new names describe the cause rather than what people don't do, and drop words some found stigmatising. Your report may use either name: NAFLD and MASLD are the same condition.

What do grade 1, grade 2 and grade 3 fatty liver mean?

On an ultrasound report, the grade describes how much fat the liver appears to have. Fat makes the liver look brighter on the scan.

Ultrasound gradeWhat it usually means
Grade 1 (mild)A small amount of fat. Very common, and the easiest to reverse
Grade 2 (moderate)More fat; the liver looks clearly brighter
Grade 3 (severe)A lot of fat; deeper parts of the liver are hard to see on the scan

The grade isn't the same as damage. An ultrasound shows fat, not inflammation or scarring. Someone with grade 1 can have scarring, and someone with grade 3 may have none. So whatever the grade, the next step is the same: a blood test score (FIB-4) and sometimes a special scan to check for scarring, plus checks for diabetes, cholesterol and blood pressure.

Is grade 1 fatty liver dangerous? On its own, usually not, and it can go away. But it's a warning sign: the same things that put fat in the liver raise the risk of type 2 diabetes and heart disease.

What are the symptoms of fatty liver?

Usually none. Fatty liver is often called a silent disease. Most people find out by chance, from a scan or blood test done for something else.

When there are symptoms, they're vague:

  • feeling very tired or generally unwell
  • a dull ache or discomfort in the upper right side of the tummy, under the ribs

The four stages (most people only ever have the first):

  1. Fatty liver (steatosis): fat in the liver, no damage
  2. MASH (formerly NASH): the liver is inflamed
  3. Fibrosis: scarring, but the liver usually still works well
  4. Cirrhosis: severe, permanent scarring

Signs of cirrhosis, the late stage:

  • yellow skin or yellow whites of the eyes (jaundice)
  • a swollen tummy, or swollen legs, ankles or feet
  • itchy skin, bruising or bleeding easily
  • poor appetite, weight loss, feeling sick
  • small red spider-like blood vessels on the skin, blotchy red palms
  • confusion, poor concentration or slurred speech
  • vomiting blood or very dark or black poo, which is an emergency

What causes fatty liver, and who gets it?

Fatty liver is closely linked to how the body handles sugar and fat. You're more likely to have it if you have:

  • overweight, especially a lot of fat around the waist and tummy
  • type 2 diabetes, prediabetes or insulin resistance
  • high blood pressure, or high cholesterol or triglycerides
  • metabolic syndrome (several of these together)
  • PCOS
  • an unhealthy diet or little physical activity
  • age over 50

In the US, rates are highest in Hispanic people. Children can get it too: close to 10% of US children aged 2 to 19 have it.

You don't have to be overweight. People of a healthy weight can have fatty liver, especially with diabetes or extra fat around the waist.

Alcohol causes its own kind of fatty liver, and it makes the metabolic kind worse. Our PCOS guide explains one of the hormone conditions linked with it.

How is fatty liver diagnosed, and how do doctors check for scarring?

Fatty liver is usually found by chance. Doctors then check how much it matters:

  • Liver blood tests (ALT and AST). These are often raised, but can be normal even with fatty liver or scarring, so a normal result doesn't rule it out.
  • An ultrasound scan shows fat in the liver and gives the grade. CT and MRI scans can also show it.
  • A scarring score (FIB-4), worked out from your age, ALT, AST and platelet count. A score below 1.3 means advanced scarring is unlikely; it's usually rechecked every 1 to 2 years. A higher score leads to the next test.
  • A special scan (elastography), such as a FibroScan, measures how stiff the liver is, or an ELF blood test looks for scarring.
  • A liver biopsy, a tiny sample taken with a needle, is the only test that proves MASH. It's needed only sometimes.

Doctors also check the conditions that go with fatty liver: blood sugar (HbA1c), cholesterol and triglycerides, blood pressure and weight, and ask about alcohol.

Is fatty liver serious?

For most people, no: they only ever have fat in the liver, without inflammation or scarring. But in some it slowly progresses:

  • MASH (inflammation) affects a small share of people with fatty liver, about 1.5 to 6.5% of US adults
  • fibrosis and then cirrhosis can follow over years
  • cirrhosis can lead to liver failure, internal bleeding and liver cancer

The higher your scarring score, the closer the follow-up.

The bigger risk for most people is the heart. The same causes that put fat in the liver raise the risk of type 2 diabetes, heart attack and stroke. Treating weight, blood sugar, blood pressure and cholesterol protects both.

Can fatty liver be reversed, and what helps?

Yes, especially in the early stages. The main treatment is lifestyle, and it works:

  • Lose weight gradually if you're overweight. Losing 3 to 5% of your body weight can reduce fat in the liver; 7 to 10% can reduce inflammation and scarring. Avoid crash diets: losing weight very fast can make liver disease worse.
  • Move more: at least 150 minutes of activity a week, such as brisk walking. Exercise helps even if your weight doesn't change much.
  • Eat a healthy, balanced diet: more vegetables, fruit, whole grains, pulses and fish, and fewer sugary drinks, sweets and processed foods.
  • Alcohol: keep to no more than 14 units a week, spread over several days. If you have scarring, or alcohol-related liver disease, your doctor may advise stopping completely.
  • Stop smoking, and get diabetes, blood pressure and cholesterol treated.

Medicines: there's no medicine for simple fatty liver. For MASH, a specialist may use pioglitazone or vitamin E in some people. In the US, resmetirom (approved in 2024) and semaglutide (approved in 2025) can be prescribed for MASH with moderate to advanced scarring, without cirrhosis, alongside diet and exercise.

Which medicine, and how much, is your doctor's decision. Don't take high-dose vitamin E, herbal remedies or "liver detox" products on your own: some supplements can harm the liver. Ask a doctor or pharmacist first.

When to see a doctor

Book an appointment

  • Told you have fatty liver (any grade) on a scan, or raised liver enzymes on a blood test: see your GP or family doctor within the next few weeks to check your scarring risk (FIB-4), blood sugar, cholesterol and blood pressure.
  • Overweight with type 2 diabetes, or several risk factors: ask about a liver check at your next GP visit.
  • Already diagnosed with fatty liver: have a check-up at least once a year, and liver tests every 2 to 3 years, or as often as your doctor advises.
  • Yellow skin or eyes: see a doctor today. A swollen tummy or legs, or itching that won't go away: see a doctor within a few days.
  • Drinking more than 14 units a week and finding it hard to cut down: talk to your doctor; help is available.

Get emergency help now (call your local emergency number) if someone has:

  • vomiting blood, or very dark, black or tarry poo
  • sudden confusion, drowsiness or slurred speech, especially with known liver disease
  • yellow skin or eyes with severe tummy pain, a high temperature or shivering
  • a swollen tummy with difficulty breathing

Fatty liver is a long-term condition that's managed over years, and most people never reach the late stage. These signs are the exceptions that can't wait. Don't drive yourself to hospital.

Fatty liver on your scan, or liver numbers you don't understand? Talk it through.

Saluvo listens to your symptoms in your own words and language, asks the right follow-up questions, and tells you which doctor to see and how soon. Already have a scan report or liver blood tests? It explains every value.

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Questions people ask

  • Usually there are none. Most people find out from an ultrasound or raised liver enzymes on a blood test done for another reason. Some people notice tiredness or a dull ache under the right ribs. Yellow skin or eyes, a swollen tummy and itching are late signs of cirrhosis, not early fatty liver.

  • Grade 1 on an ultrasound report means mild fatty liver: a small amount of fat makes the liver look slightly brighter on the scan. It's very common and the easiest grade to reverse. The grade shows fat, not scarring, so your doctor may still check a scarring score (FIB-4), blood sugar, cholesterol and blood pressure.

  • On its own, usually not, and it can go away with steady weight loss, more activity and less alcohol. But it's a warning sign: the same causes raise the risk of type 2 diabetes and heart disease. Ask your doctor about a scarring score and checks for blood sugar, cholesterol and blood pressure.

  • MASLD stands for metabolic dysfunction-associated steatotic liver disease. It's the name the international liver societies gave in June 2023 to what was called non-alcoholic fatty liver disease (NAFLD): fat in the liver linked to weight, blood sugar, blood pressure or blood fats. Its inflamed form, NASH, is now called MASH. They're the same conditions with new names.

  • Yes, especially early on. Losing 3 to 5% of your body weight can reduce liver fat, and 7 to 10% can reduce inflammation and scarring. Regular activity, a balanced diet and cutting down on alcohol and sugary drinks all help. Lose weight gradually: very fast weight loss can make liver disease worse. Cirrhosis scarring is permanent, but it can be stopped from getting worse.

  • It varies. Liver fat can start to fall within weeks to months of steady weight loss and more activity, and a repeat scan or blood test can show the change. Inflammation and scarring take longer to improve, if they do. Aim for slow, lasting changes rather than a quick fix, and ask your doctor when to recheck.

  • Usually not. Some people feel a dull ache or discomfort in the upper right side of the tummy, under the ribs. Severe tummy pain, especially with yellow skin or eyes or a fever, isn't typical of fatty liver and needs a doctor urgently, as it can be a gallbladder or other problem.

  • Yes. People of a healthy weight can have fatty liver, especially with type 2 diabetes, high blood pressure, high blood fats or extra fat around the waist. The tests and the advice are the same: a scarring score, checks for blood sugar and cholesterol, regular activity, a balanced diet and less alcohol.

  • A healthy, balanced diet: plenty of vegetables, fruit, whole grains, pulses, fish and lean protein, with fewer sugary drinks, sweets, refined carbohydrates and processed or fried foods. No single food cures fatty liver. Eating a little less overall, so you lose weight slowly if you need to, matters most. Be wary of 'liver detox' products.

  • Keep to no more than 14 units a week, spread over several days, with some alcohol-free days. Alcohol adds to the damage, so less is better. If you have scarring (fibrosis or cirrhosis) or alcohol-related liver disease, your doctor may advise stopping completely. If cutting down is hard, ask your doctor for help.

  • Yes. Liver enzymes (ALT and AST) are often raised in fatty liver, but they can be normal even when there's fat or scarring. That's why doctors use an ultrasound to see the fat, and a scarring score (FIB-4), elastography or an ELF test to look for scarring, rather than relying on liver enzymes alone.

  • Yes, closely. Insulin resistance helps put fat in the liver, and fatty liver makes blood sugar harder to control. Many people with type 2 diabetes have fatty liver, and they're more likely to have scarring. If you have one, it's worth being checked for the other: an HbA1c test for diabetes, and a FIB-4 score for the liver.

  • Yes. Close to 10% of US children aged 2 to 19 have fatty liver, mostly linked to extra weight. It usually has no symptoms. If a child is overweight, a doctor may check their liver along with blood sugar and blood fats. Healthy family habits, more activity and fewer sugary drinks help most.

Tests that help

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Sources

  1. NHS: Non-alcoholic fatty liver disease (NAFLD), also known as MASLD
  2. NIDDK (NIH): NAFLD and NASH, symptoms and causes
  3. NIDDK (NIH): NAFLD and NASH, diagnosis
  4. NIDDK (NIH): NAFLD and NASH, treatment
  5. AASLD: New MASLD nomenclature (2023)
  6. NHS: Cirrhosis, symptoms
  7. US FDA: First treatment approved for liver scarring due to fatty liver disease (2024)

Updated . Health information, not medical advice. Your doctor knows your full picture; ask them about your result.