Rising tide of little-known liver disease prompts calls for greater awareness and lifestyle changes

Nicky Pellegrino

Health writer·New Zealand Listener·

20 Jul, 2026 06:06 PM4 mins to read

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The liver is a highly sensitive organ, but tends to soldier on and not display any sign of distress until it is in very poor shape. Photo / Getty Images

Despite being the most common liver disease in the developed world, affecting up to one in three adults, Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) isn’t getting enough attention. The non-catchy name probably isn’t helping (it used to be known as non-alcoholic fatty liver) and an international review has found
no country is well enough prepared to manage a health problem that will affect an estimated 1.8 billion people by 2050.

Obesity increases the risk of developing MASLD, particularly having body fat around the waist, but it can also affect leaner bodies. It is linked to type 2 diabetes, higher lipid (especially triglyceride) levels, inactivity and poor diets. Some people may be at higher genetic risk of developing the condition.

With MASLD, too much fat builds up in the liver, causing inflammation. Longer term, this damages cells and can progress to liver failure or cancer.

The liver is a highly sensitive organ, but tends to soldier on and not display any sign of distress until it is in very poor shape. Most people with MASLD have no obvious symptoms, and diagnosis tends to happen after a blood test shows poor liver function, and other causes, such as infection or drinking too much alcohol, have been eliminated.

The science is showing even a short stint of poor lifestyle choices has a temporary impact on the liver. Public health specialist Dr Kirsten Coppell was one of a small group of women who took part in the Trigger study at the University of Otago, where she is an associate professor. The aim was to look at which diets trigger more fat in the liver by getting a group of pre-menopausal women of normal weight to gain kilos. They upped their calorie intake by increasing saturated fats and refined carbohydrates. “I thought, if we were going to ask other people to do this, I should put my hand up,” says Coppell of her decision to become a participant.

She began with four weeks of eating lots of refined carbohydrates. After a break to reset her system, she spent another four weeks increasing the saturated fats in her diet.

“I was under the guidance of a dietitian and she gave me a list of foods that I had to eat more of,” says Coppell. “It was chocolate bars and big date scones for morning tea. I had no problem putting weight on and grew out of all my trousers except one pair in the first four weeks. Also, I felt terrible.”

Both of the high-calorie diets raised liver fat content for participants: the high carbohydrate by 53.9% and the high fat by 35.3%.

A similar rapid rise has been seen in other studies where people have consumed things like sugary fizzy drinks every day or lots of butter for a relatively short period of time.

In the early stages, MASLD can be slowed or even reversed. However, there is no targeted medication, and treatment relies on lifestyle changes. Diet is key. The Trigger study had a second intervention stage where people with confirmed fatty liver problems were asked to try one of two weight-loss diets. Both led to some liver fat reduction.

Although the new GLP-1 weight-loss medications such as Wegovy have a role to play, they are expensive, don’t work for everyone and still require lifestyle changes.

“We live in an environment that doesn’t encourage us to make healthy choices,” says Coppell, who, as part of a new study, has been putting together a photo essay, snapping pictures outside food shops. “When you start looking, you realise how much messaging there is. Sometimes, it’s the whole front of a dairy, just full of that temptation.”

Her ongoing research into lifestyle change for wellbeing has shown, for a chance of succeeding, people need guidance and support. She believes medics and health coaches must help deliver that.

There are at least some signs MASLD is starting to get the attention it needs. With a rise of people in their 20s and 30s developing the disease, Australia has launched a national research programme to fast-track prevention, diagnosis and treatment. Meanwhile, researchers from Sydney’s Centenary Institute have developed a new diagnostic tool called the FAP-Index, which could improve how doctors identify people at risk of serious liver damage caused by metabolic fatty liver disease.

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