In short: In 2023, international liver societies renamed non-alcoholic fatty liver disease (NAFLD) as metabolic dysfunction-associated steatotic liver disease, or MASLD. The new name ties fatty liver to the things that usually drive it: excess weight around the waist, blood sugar, blood pressure and blood fats. Around three in ten adults have it, including in Korea, and the main treatment is still lifestyle: gradual weight loss, a better-quality diet, more movement and less alcohol.
Last reviewed: November 2026
Why the name changed
For decades, doctors defined fatty liver by what it was not: fat in the liver that was not caused by heavy drinking. That definition had two problems. It said nothing about the actual cause, and many patients found the words ‘non-alcoholic’ and ‘fatty’ stigmatising.
In June 2023 a Delphi consensus process led by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL) and the Latin American liver association agreed on new terms. A total of 236 experts and patient advocates from 56 countries took part. The new vocabulary looks like this:
- Steatotic liver disease (SLD) – the umbrella term for any build-up of fat in the liver.
- MASLD – fat in the liver plus at least one cardiometabolic risk factor, with little or no alcohol. This replaces NAFLD.
- MASH – the inflamed, more serious form, replacing NASH.
- MetALD – MASLD in people who also drink a moderate-to-large amount: roughly 140–350 g of alcohol a week for women and 210–420 g for men.
- ALD – liver disease driven mainly by alcohol.
Researchers have since checked whether decades of NAFLD research still applies. The 2024 EASL guideline concluded that almost everyone with NAFLD also meets the MASLD definition, so the existing evidence carries over.
The five cardiometabolic risk factors
To be diagnosed with MASLD, an adult needs fat in the liver (usually seen on ultrasound or another scan) plus at least one of these:
- Body size: BMI of 25 or more, or 23 or more for people of Asian background, or a waist measurement above about 94 cm for men and 80 cm for women (cut-offs vary by ethnicity).
- Blood sugar: fasting glucose of 5.6 mmol/L (100 mg/dL) or higher, HbA1c of 5.7% or higher, type 2 diabetes, or treatment for it.
- Blood pressure: 130/85 mmHg or higher, or treatment for high blood pressure.
- Triglycerides: 1.70 mmol/L (150 mg/dL) or higher, or treatment.
- HDL (‘good’) cholesterol: 1.0 mmol/L (40 mg/dL) or lower for men, 1.3 mmol/L (50 mg/dL) or lower for women, or treatment.
The Asian BMI cut-off matters. Many Koreans who would be called ‘normal weight’ by Western charts sit above 23, and East Asian populations tend to develop metabolic problems at a lower body weight. This is one reason MASLD is common in Korea even among people who do not think of themselves as overweight.
How common is it?
Globally, about 30% of adults are estimated to have MASLD. Korean national survey data put the figure in a similar range: one analysis of the Korea National Health and Nutrition Examination Survey found prevalence rose from 25.0% in 2007–2009 to 31.0% in 2022–2023, with the fastest rise in adults aged 19–44. A separate 2026 analysis by the Korea National Institute of Health, using a different method, found 24.1%. Either way, roughly one adult in four to one in three is affected.
Why it matters
Most people with simple fat in the liver never develop serious liver damage. But MASLD is a spectrum. In some people the fat triggers inflammation (MASH), which can lead to scarring (fibrosis), cirrhosis and, in a minority, liver cancer. MASLD is also closely linked to type 2 diabetes and heart disease, which are in fact the most common causes of death in people with fatty liver.
The difficult part is that MASLD usually causes no symptoms until it is advanced. It is often found by accident on an ultrasound or after a routine blood test shows raised liver enzymes. Guidelines now recommend that people with type 2 diabetes, obesity or several metabolic risk factors be checked for liver scarring using simple tests, starting with a blood-based score called FIB-4. If any of the risk factors above apply to you, it is worth asking your GP about it.
What the guidelines recommend
The 2024 joint guideline from EASL and the European diabetes and obesity associations puts lifestyle change first: weight loss, dietary change, physical activity and cutting down on alcohol, alongside treatment of diabetes, blood pressure and cholesterol. Newer medicines exist for people with advanced inflammation and scarring, but they are prescribed by specialists and do not replace lifestyle change.
Commonly cited weight-loss targets for people carrying excess weight are:
- About 5% of body weight to reduce liver fat.
- About 7–10% to improve inflammation.
- 10% or more to give the best chance of improving scarring.
- For people with MASLD at a lean weight, a modest 3–5% loss may still help.
Slow, steady loss through eating and activity changes is the goal. Crash diets are not recommended and can be harmful for the liver. If you have MASLD, any weight-loss plan is best made with your doctor or an Accredited Practising Dietitian.
Several guidelines recommend a Mediterranean-style eating pattern, which is the most studied diet for MASLD. Many experts recommend avoiding alcohol entirely once there is significant scarring.
What this means in a Korean kitchen
A Mediterranean diet is built on vegetables, legumes, whole grains, fish and olive oil, with little processed food or added sugar. A traditional Korean table already shares much of that.
Strengths worth keeping:
- Lots of vegetables, especially namul (seasoned vegetables) and soups built on vegetables and seaweed.
- Soy foods such as tofu, doenjang and soybean sprouts.
- Fish, including oily fish like mackerel (godeungeo) and saury (kkongchi).
- Sesame and perilla oil used in small amounts for flavour.
Weak spots worth adjusting:
- Large bowls of white rice. Mixing in barley, brown rice or other grains (japgok-bap) and using a smaller bowl adds fibre and slows the rise in blood sugar.
- Sweet banchan and sauces. Jorim (braised dishes), bulgogi marinades and tteokbokki sauce often contain plenty of sugar, corn syrup or oligosaccharide syrup.
- Sugary drinks. Sweetened sodas, juices and 3-in-1 coffee mix sachets add up quickly. Reducing sugar-sweetened drinks is a common recommendation for MASLD.
- Salt. Sodium is not a direct cause of fatty liver, but high blood pressure is one of the five MASLD risk factors. Stews, soup broths, kimchi and dipping sauces are the biggest contributors.
- Drinking culture. Even moderate alcohol makes liver injury worse when metabolic risk factors are present. A bottle of soju contains more alcohol than many people realise.
The recipes on this site are built around those adjustments. The idea is not to stop eating Korean food. It is to tilt it towards what it already does well.
The bottom line
MASLD is the new name for fatty liver linked to metabolic health. It is common, usually silent, and largely driven by the same factors that raise the risk of diabetes and heart disease. If any of the five risk factors apply to you, talk to your GP about a liver check. In the kitchen, gradual weight loss, fewer sugary foods and drinks, more vegetables and whole grains, and less alcohol are what the evidence supports.
This article is general information, not medical advice. See our Medical Disclaimer and Editorial Policy.
Sources
- Rinella ME, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Journal of Hepatology. 2023;79(6):1542–1556.
- European Association for the Study of the Liver, EASD, EASO. EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. Journal of Hepatology. 2024;81(3):492–542.
- Rinella ME, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797–1835.
- Kwon J, et al. Trends in prevalence of MASLD: a nationwide survey in Korea. Endocrinology and Metabolism. 2025.
- Korean Association for the Study of the Liver. KASL clinical practice guidelines for the management of MASLD 2025. Clinical and Molecular Hepatology. 2025.