Can Fatty Liver Disease Be Genetic? How Your DNA Influences MASLD Risk

Is Fatty Liver Disease Genetic? Understanding the Role of Genes in MASLD Risk

We’ve all got that one family member who says, “It runs in the family.” For once, they might be right. While lifestyle drives most cases of fatty liver disease (MASLD), your genes can stack the odds against you too.

In my clinic, I often meet people frustrated because they eat similarly to friends or family, yet develop liver issues while others don’t. Genetics explains a lot of that difference. But here’s the truth: even with ‘bad genes’, you’re not doomed.

Can You Inherit a Risk for Fatty Liver Disease (MASLD)?

Yes. While diet, weight, and metabolic health remain the biggest players, research shows certain gene variations can increase your risk of developing MASLD, and how fast it progresses. This is why two people with similar lifestyles might have totally different liver outcomes.

Which Genes Are Linked to MASLD and Liver Damage?

The most studied MASLD-related genes include:

• PNPLA3 (I148M variant) - the strongest known risk factor. It raises fat storage in the liver, inflammation, scarring and even liver cancer risk.

• TM6SF2 (E167K variant) - increases liver fat by reducing your ability to export it. Interestingly, it can lower blood fats, showing how complex this gets.

• GCKR - affects glucose handling in the liver, driving more fat production.

• MBOAT7 - linked to higher rates of inflammation and scarring.

• HSD17B13 - ironically protective. People with this gene tend to have less liver damage, even with other risk factors.

Some of these variants are more common in certain ethnicities which partly explains global differences in MASLD rates.

If I Have These Genes, Does It Mean I’ll Get Fatty Liver

No, and this is where people go wrong.

What I see in clinic:
Clients often come to me panicking about their “fatty liver gene” after an ancestry test. But it’s not destiny. Those genes might raise your risk, but it’s your lifestyle, diet, metabolic health and weight that determine whether that risk gets activated.

The mistake?
Focusing on the gene and ignoring the controllable factors. Or worse, using genetics as an excuse to give up. What I do is assess their full picture: labs, family history, weight trends, diet habits, and muscle mass (because remember, muscle loss matters more than BMI for liver outcomes).

How Can Diet and Lifestyle Still Make a Difference with a Genetic Risk?
Even if you carry risky gene variants, evidence shows lifestyle changes can offset that genetic load:

• Cut added sugars and refined carbs to reduce fat production in the liver

• Prioritise high-fibre, plant-rich meals to lower inflammation and improve gut health

• Protect your muscle mass, sarcopenia worsens outcomes even in normal-weight people

• Manage visceral fat with sustainable calorie control and movement

• Consider coffee , multiple studies show coffee drinkers have less liver scarring. Be mindful if you have IBS though, as coffee makes symptoms worse.
  

Your genes load the gun. Your lifestyle pulls (or doesn’t pull) the trigger.

What I See in Clinic: Mistakes People Make and How I Support Them

The biggest mistake? Obsession with BMI while ignoring function, frailty, and muscle mass. I’ve had slim, young patients with fatty liver and zero strength or resilience — textbook malnutrition and sarcopenia.

How I support them:
I take a holistic nutrition and function-focused approach:

• Full dietary assessment (macros, fibre, processed foods)

• Muscle strength and body composition review

• Tailored anti-inflammatory, high-protein, fibre-rich meal plans

• Actionable advice, not generalised tips from Google
  

It’s not about perfection. It’s about reducing the pressure on a vulnerable liver.

FAQs

Is MASLD hereditary?
Yes, genetics can increase your risk, but lifestyle factors are still the biggest cause.

Can genetic tests tell if you’ll get fatty liver disease?
They can identify risk variants, but they don’t predict outcomes. Your habits decide that.

What diet is best if you have a genetic risk for MASLD?
A Mediterranean-style, anti-inflammatory, high-fibre diet rich in plant foods, healthy fats, and quality protein.

What I see in clinic:
Plenty of people think high blood pressure’s ‘just a heart thing’. But every time we improve their diet for liver fat, we see blood pressure readings drop too. We also see changes in fluid build up (ascites and oedema), so actually improving protein intake and adjusting added salt intake makes a big difference.

Bad genes? Tough luck. But bad habits? That’s fixable.

Book a liver nutrition assessment with me today and get a tailored strategy that respects your DNA and protects your liver.

How can I help you?

If you’d like expert, tailored support, book a consultation today at The Liver Nutrition Clinic. I’m Bally Parekh, MSc RD, Specialist Liver Dietitian, and I’d love to help you stay stronger for longer.

How can we help

At MESH Performance, Specialist Liver Dietitian Bally Parekh MSc. RD provides evidence-based nutrition support for those living with liver conditions. Our approach focuses on:

• Sarcopenia and frailty assessments

• Maintaining and rebuilding muscle to reduce the risk of frailty and malnutrition

• Implementing targeted dietary strategies to support overall well-being and quality of life

• Optimising nutrition to prevent deficiencies and support energy level

Managing a liver condition comes with challenges, but the right nutrition can make a real difference. We're here to provide practical support—let’s get started.

Our Instagram