The 4 Key Metabolic Risk Factors Driving Fatty Liver Disease (MASLD) and How to Manage Them

Understanding the 4 Metabolic Risk Factors Behind MASLD (Fatty Liver Disease)

If MASLD (fatty liver disease) had a group chat, the four people causing all the drama would be obesity, type 2 diabetes, high cholesterol, and high blood pressure. You might not always notice them, but trust me, they’re behind nearly every bad decision your liver makes.

What Is the Role of Obesity and Visceral Fat in MASLD?

Obesity, especially the kind that gathers around your middle (visceral fat), is a major driver of MASLD. It’s not just the extra weight, it’s about where you carry it and how your fat cells behave. Visceral fat is more metabolically active, releasing harmful fatty acids and inflammatory chemicals into your bloodstream, which head straight to your liver.

What I see in clinic:

People often fixate on BMI, but I’ve worked with many slim individuals with MASLD because it’s visceral fat, not just total weight, that matters most. Waist circumference, muscle mass, and function and frailty scores tells me more about your risk than the number on the scales.

How Does Type 2 Diabetes Increase the Risk of Fatty Liver Disease?

Type 2 diabetes and MASLD go hand in hand. Insulin resistance, where your body stops responding properly to insulin, causes excess fat to build up in the liver and raises blood sugar levels. What makes it worse is that MASLD itself increases the risk of developing type 2 diabetes, creating a dangerous feedback loop.

What I see in clinic:
Many people with fatty liver first come in after a diabetes diagnosis, unaware their liver’s been struggling too. We work hard with each client, improving their diet and activity often benefits both conditions together. There is no one-size fits all approach in the scenario.

Why Is Dyslipidemia (high cholesterol) a Problem in MASLD?

Dyslipidemia refers to high triglycerides and low HDL (good cholesterol). In MASLD, this happens because the liver’s handling of the "fat" becomes faulty, it produces too much fat and struggles to get rid of it. This raises your risk of heart disease alongside liver scarring.

What I see in clinic:

Clients are often told about their cholesterol, but no one links it to their liver health. Addressing liver fat through diet and weight loss nearly always improves lipid profiles too, it’s one of the quickest wins we see. We also avoid long term keto-genic diets in this scenario, as extremely large amounts of saturated fat can make this worse.

In early stages, this can halt and even reverse damage. In later stages, targeted support with specific nutrients and antioxidants becomes even more crucial.

Is There a Link Between High Blood Pressure and Liver Disease?

Yes, and it’s stronger than people realise. Insulin resistance, inflammation, and poor blood vessel function connect MASLD and high blood pressure. Left unchecked, they increase the risk of advanced liver disease and heart problems.

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.

What Can I Do to Improve These Metabolic Risk Factors Today?

Here are five simple, evidence-based changes I’ve seen consistently work for my clients:

1. Prioritise fibre - oats, beans, lentils, and veg help regulate blood sugar, cholesterol, and gut health.
   

2. Reduce added sugars and refined carbs, especially soft drinks, white bread, and snacks.
   

3. Add healthy fats, nuts, seeds, olive oil, and oily fish improve cholesterol and reduce inflammation.
   

4. Aim for regular movement, even 20-minute walks after meals improve insulin sensitivity.
   

5. Watch your waist, not just your weight, track waist circumference alongside the scales.
   

FAQs

Can you have MASLD if you’re not overweight?
Yes, especially if you have visceral fat or insulin resistance. This is called ‘lean MASLD’.

Does losing weight reverse fatty liver disease?
It can, particularly if you lose 7–10% of your body weight. Even 3–5% makes a difference. You should work with a specialist Liver Dietitian to make sure you do this safely.

What diet is best for MASLD?
A Mediterranean-style, high-fibre, low-sugar diet, rich in whole plant foods and healthy fats is consistently recommended.

If you think you’re fine because your BMI’s ‘okay’, your blood sugar’s “a little high” or you’re on “just one blood pressure tablet,” your liver might have something to say about that.

Want to get ahead of it?

Get in touch below.

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.

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