MASLD (fatty liver disease) – Bradford Teaching Hospitals NHS Foundation Trust

What is MASLD?

Formally known as Non Alcoholic Fatty liver disease (NAFLD) or Fatty Liver Disease, has now been renamed as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). It is a condition that is caused by a buildup of fat which is stored in the liver.

This condition can lead to liver inflammation, cirrhosis (scarring in the liver) and if not managed properly eventually liver cancer. It is often linked to metabolic risk factors such as obesity, diabetes, and cardiovascular disease.

Non-alcoholic fatty liver and steatohepatitis are reversible. Cirrhosis is irreversible.

Evolution of non-alcoholic fatty liver disease. Created with BioRender by The Conversation.

What are the symptoms?

You are likely to have no symptoms with MASLD and may only be detected with a blood test.

If the condition progresses to cirrhosis you may experience some of the below symptoms; however, these are often only experienced in advanced liver disease:

fatigue
decreased appetite
nausea
abdominal pain
abdominal swelling
jaundice (yellowing of the skin and eyes)
dark urine

How does it get diagnosed?

Diagnosis typically involves a combination of:

blood tests: checking liver enzyme levels
fibroscan: measuring liver stiffness
imaging tests: ultrasound, CT, or MRI to identify liver changes
liver biopsy: a sample of liver tissue to confirm the diagnosis

How common is MASLD?

MASLD is estimated to affect up to 1 in 5 people (20%) in the UK, making it one of the most common liver conditions.

How can MASLD be managed?

General tips to improve symptoms:

maintain a healthy weight through diet and exercise
avoid alcohol and smoking
manage underlying conditions like diabetes and high cholesterol

Do

eat a balanced diet rich in fruits, vegetables, and whole grains
engage in regular physical activity
monitor and manage blood sugar levels

Don't

don’t drink to excess – aim to drink within recommended guidance (14 units of alcohol per week spread across 3 days or more)
avoid sugar sweetened drinks – limit intake of sugary beverages including fruit juice
avoid ultra processed foods – cook from fresh ingredients where possible
avoid crash diets which can worsen liver conditions

Useful links

Weight loss

Weight loss goals

If you are in the overweight or obese weight category 7-10% weight loss would help reverse the damage within your liver.

If your weight is within the healthy weight category, a weight loss of 3-5% is recommended.

Aim for a gradual weight loss of 1-2 pounds per week. This can significantly improve liver health and reduce fat accumulation.

You should aim for a BMI within the healthy weight range. This is between 18.5 and 24.9 if you are Caucasian and between 18.5 and 22.9 if you are from an Asian, Chinese, Middle Eastern, Black African or African Caribbean family background. You can use the BMI calculator (NHS.UK) to work out your current BMI.

Weight loss tips

Set realistic weight loss goals and monitor your progress.
Losing more than 10% of your weight can remove some fat from the liver and has shown to reverse the inflammation and damage.
Aim for three regular, balanced meals a day.
Aim to reduce your portion size.
Aim for half your plate to be vegetables/salad and divide the other half between protein and carbohydrate.
Aim to drink 6-8 glasses of water a day.
Take time out to eat your meals slowly so that you can focus on and enjoy your food.
Incorporate more physical activity into your daily routine.
Get support to help you along your journey.

If you feel like you need more support with your weight and weight loss please contact your GP or hepatology service and request onward referral.

Useful links

Nutrition

The Eatwell Guide

Eatwell guide: pie chart
The Eatwell Guide shows the proportions of the types of foods that you need from each food group overall to achieve a healthy, balanced diet. You don’t have to get the balance right with every meal, but aim to get the proportions right over a day or even a week.

Learn more about Eatwell

The Eatwell Guide shows the proportions of the main food groups that form a healthy, balanced diet:

Eat at least 5 portions of a variety of fruit and vegetables every day
Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing wholegrain versions where possible
Have some dairy or dairy alternatives (such as soya drinks); choosing lower fat and lower sugar options
Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily)
Choose unsaturated oils and spreads and eat in small amounts
Drink 6-8 cups/glasses of fluid a day
If consuming foods and drinks high in fat, salt or sugar have these less often and in small amounts

Ultra processed foods (UPFs)

UPFs are foods which you buy from a shop or food outlet which has had additional processing. It can make the food have a long shelf life and can include many additives and ingredients that are not used in home cooking. These added ingredients include; preservatives, emulsifiers, sweeteners, artificial colours and flavours. UPFs should be reduced within your daily diet.

Ultra-processed foods: how bad are they for your health? – BHF

Useful resources

The Mediterranean Diet

The Mediterranean diet gives you some specific ways to incorporate healthy eating principles into your daily diet. Eating a more Mediterranean style diet has shown to help improve liver inflammation.

Mediterranean principles

The Mediterranean diet can be incorporated into any dietary habits. You can make any meal more Mediterranean by following the below principles:

focus on plant foods like fruit, vegetables, whole grains, nuts, seeds, and pulses
include moderate amounts of lean proteins like fish and chicken and low-fat dairy foods
focus on healthy fats so olive oil is used to replace other oils and fats in the diet
incorporate foods high in omega-3 fatty acids like fish and nuts
limit intake of red meat and high-fat dairy products

5 top tips for making your meals more Mediterranean

1. Eat more fruit and salad

Fresh, frozen, canned or dried. Aim for at least five servings every day, or more if you can, and include a wide variety. Make sure you eat fruit and vegetables at every meal and choose them as snacks and puddings too. These foods are rich in essential nutrients and also low in calories. Make a green salad more interesting by introducing tomatoes and peppers, and fruits such as figs, pomegranates, citrus fruits and grapes.

2. Starchy carbohydrate foods

Base your meals on foods such as bread, noodles, chapati, rice, pasta and yams. Wholegrain varieties are generally higher in fibre, so they are good for digestive health too. 1/4 of your plate or a fist size portion of carbohydrate per meal is the portion size to aim for.

3. Have meat-free days

The Mediterranean diet typically includes more fish and less meat. White fish is low in fat and calories, so they’re helpful when managing weight. Oily fish, although higher in fat, contain essential omega-3 fats and vitamin. Going for fish, beans and pulses is a good way to increase your protein.

4. Focus on good fats

Unsaturated fats are the main type of fat used in the Mediterranean, most famously olive oil. Replace butter, lard and ghee with unsaturated oils from plants and seeds such as olive and rapeseed oil. This can help to lower your cholesterol levels.

5. Nuts and butters

Choose unsalted varieties. Nuts are rich in monounsaturated fats. As a guide, try to eat about 30-35g (a handful) each day.

How to adapt meals

Home cook meals where possible
If eating red meat, but a lean cut and trim the fat
Replace some of the meat with pulses or lentils
Grill foods instead of frying
Flavour meals with herbs and spices instead of salt
Measure oil used in cooking i.e. 1 tsp per person per meal
Serve extra veg/salad with meals i.e. ½ plate
Swap cream for fat-free plain yoghurt in curries

Useful resources

Type 2 Diabetes

You are more at risk of developing Type 2 Diabetes if you have MASLD, and the converse is also true, as both conditions are linked to metabolic disorders and obesity. Having good blood glucose control is important to reduce your risk of worsening fatty liver disease and the complications associated with diabetes.

Bradford Dietetic Diabetes Service have a large variety of education sessions available to you from ‘Getting Started’ advice for newly diagnosed patients to dietary advice when taking insulin, to name just two. There are also practical sessions including supermarket tours.

If you are concerned about your diabetes control, please speak to your GP or self-refer to the Diabetes Dietetic service for more specific dietary advice related to your diabetes.

Diabetes Dietetic telephone numbers: 01274 277454 or 01274 365884

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Healthy Living

For people with type 2 diabetes
Register for the programme

Physical activity

Adults should aim to:

do strengthening activities that work all the major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week
do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week
spread exercise evenly over 4 to 5 days a week, or every day
reduce time spent sitting or lying down and break up long periods of not moving with some activity

You can also achieve your weekly activity target with:

several short sessions of very vigorous intensity activity
a mix of moderate, vigorous and very vigorous intensity activity

Slowly build up the amount of activity you do so that it becomes part of your daily routine. Find things you enjoy doing, so it is easier to keep doing them. Walking more is often a good way to start, especially with a friend.

Look for easy ways to fit more movement into your day-to-day routine. For example, stand up when on the phone, park a bit further away from your destination, take the stairs or get off the bus a stop earlier.

Adults should do some type of physical activity every day.

Join the Bradford Encouraging Exercise in People (BEEP) programme and get 52 weeks of regular support with trained practitioners.

Physical activity recommendations

Physical activity recommendations
Intensity	Description	Examples	Aim	Links
Moderate	Will raise your heart rate, and make you breathe faster and feel warmer. One way to tell if you’re working at a moderate intensity level is if you can still talk, but not sing. Most moderate activities can become vigorous if you increase your effort.	brisk walking water aerobics riding a bike dancing pushing a lawn mower hiking	At least 150 mins of moderate or 75 minutes of vigorous intensity activity a week	Walking for health (NHS.UK)
Vigorous	Makes you breathe hard and fast. If you’re working at this level, you will not be able to say more than a few words without pausing for breath.	running swimming riding a bike fast or on hills walking up the stairs sports, like football, rugby, netball and hockey skipping aerobics gymnastics martial arts		For a moderate to vigorous workout, Get running with Couch to 5K (NHS.UK), a 9-week running plan for beginners.
Very vigorous	Exercises performed in short bursts of maximum effort broken up with rest. This type of exercise is also known as High Intensity Interval Training (HIIT).	lifting heavy weights circuit training sprinting up hills interval running running up stairs spinning classes
Muscle-strengthening	To get health benefits from strength exercises, you should do them to the point where you need a short rest before repeating the activity. There are many ways you can strengthen your muscles, whether you’re at home or in a gym.	carrying heavy shopping bags yoga pilates tai chi lifting weights working with resistance bands doing exercises that use your own body weight, such as push-ups and sit-ups heavy gardening, such as digging and shovelling wheeling a wheelchair lifting and carrying children	At least 2 days a week	Fitness Studio exercise videos (NHS.uk)

Sleep hygiene

‘Sleep hygiene’ is the term used to describe healthy habits that you can practice during the day to help you get a good night’s sleep. Sleep is essential for your physical and mental wellbeing. It allows your body time to recharge and your mind to process information. Without enough quality sleep, our brains are unable to function properly.

Good sleep hygiene can help improve your sleep quality, which in turn can:

help you maintain a healthy weight
lower your risk of developing serious health conditions (such as diabetes and heart disease)
help your body fight off diseases

How can I improve my sleep hygiene? 10 top tips.

Keep regular sleep hours. Going to bed and getting up at roughly the same time every day (including on weekends and free days) will help regulate your body clock and will train your body to rest and remain alert at certain times of the day.

Tips for improving your sleep hygiene:

Create a restful bedroom environment by keeping your bedroom dark, quiet and at a comfortable temperature.
Only use your bedroom for sleep – avoid watching television, listening to the radio or reading in bed. This will help your brain to recognise your bed as a place for sleeping.
Stop using electronic devices before going to bed– this includes computers, smart phones and televisions, as they can all stimulate your brain for several hours after use, making falling asleep difficult.
Avoid stimulants after lunch -caffeine can take up to six hours to wear off, so avoid anything containing caffeine after 2pm. This includes coffee, tea, energy drinks and chocolate.
Avoid smoking before going to bed – Nicotine is a stimulant and will keep you awake.
Eat a light meal before going to bed – going to bed too full can force your digestive system to keep working when it should be resting. Likewise, going to bed hungry can also disturb your sleep.
Exercise regularly during the day– exercising during the day can help you have a better night’s sleep. However, vigorous exercise within three hours of going to bed may delay your sleep. Try doing a relaxing exercise before going to bed to help you sleep, such as yoga.
Create a relaxing bedtime routine – when you are stressed or anxious, your body produces more cortisol (the stress hormone). Give yourself one to one and a half hours to wind down before going to sleep.

The key to good sleep hygiene is consistency. Find out what tips work best for you and create your own sleep hygiene checklist to help you get the best sleep possible each night.

Try meditating or having a warm bath before going to bed.
Limit or avoid taking naps during the day– staying awake during the day will make you more likely to fall asleep at night. Taking a nap late afternoon or in the evening is likely to affect the quality of your night-time sleep. If you do take a daytime nap, this should be no more than 30 minutes.

How much sleep do I need?

There is no set rule as to how much sleep you need. The amount of sleep needed varies from person to person. Sleep patterns can also vary with age, with older people often needing less sleep than younger adults.

Good sleep hygiene practices include maintaining a regular sleep schedule, creating a restful environment, and avoiding screens before bedtime. Proper sleep is crucial for overall health and can help manage MASLD.

Useful links

Mental health support

Living with a chronic condition like MASLD can impact mental health. Accessing mental health support, such as counseling or joining support groups, can be beneficial. Mindfulness and relaxation techniques can also help manage stress.