MASLD (fatty liver)
MASLD — metabolic dysfunction-associated steatotic liver disease, formerly called NAFLD — is fat accumulating in the liver in someone whose liver is not being damaged primarily by alcohol. It is usually silent and is often noticed as an incidental finding.
What it is
Liver cells store some fat normally. In MASLD the amount rises well beyond that, and in a proportion of people the liver also becomes inflamed, which over years can lead to scarring. Most people never reach that stage, but the trajectory is why it is followed rather than ignored.
The name changed for a reason worth knowing: the older term defined the condition by what it was not (not alcohol-related), while the current one names what it usually accompanies — metabolic dysfunction, typically insulin resistance and central fat.
It is generally silent. Fatigue and vague discomfort under the right ribs are sometimes described, but they are non-specific and neither confirms nor rules anything out.
How it is actually assessed
Liver enzymes, ALT and AST, are the values most often followed, but they are an imperfect proxy: they can be normal while fat is present, and they rise for many reasons that have nothing to do with the liver's fat content.
What settles the question is imaging — an ultrasound, or elastography that estimates stiffness — and that is a clinical decision, not something a tracking app substitutes for. This is a case where the numbers you can follow at home genuinely do not close the question.
What influences the tracked measurements
The evidence points at the same metabolic levers rather than at anything liver-specific. General information; anything involving medication or a diagnosis is the physician's.
- Central and total body fat — the change most consistently associated with reduced liver fat, and the reason weight and waist sit among the primary measurements here.
- Sugary drinks and fructose load — of the dietary factors, this one is singled out most often in the liver-specific literature.
- Regular movement — associated with less liver fat even where body weight barely changes.
- Alcohol — even though MASLD is defined as not primarily alcohol-driven, alcohol still adds to the same organ's burden.
- The metabolic neighbours — glucose, HbA1c, triglycerides and HDL are followed alongside because the conditions travel together.
Enzyme values are context, not a verdict. Whether imaging or referral is warranted is decided by a physician.
Which measurements are tracked
Two liver enzymes lead here, paired with body measurements — and, because the condition rarely travels alone, the glucose and lipid values from the same blood panel.
How tracking it in one place helps
Cardiometabolic brings readings from your connected devices, your lab results and your own journal into one picture: how the measurements move across weeks and months, what changed, and which questions are worth asking. The analysis is AI-assisted and advisory, not diagnostic. You can grant view access to a physician or a relative — read-only and only with your explicit consent, which you can withdraw.
The platform is in closed beta — registration is by invitation. Request an invite or sign in to your account.
Frequently asked questions
Can normal liver enzymes rule it out?
No. ALT and AST can sit within their reference range while fat is present, which is why they are followed as context rather than treated as a test for the condition. Imaging is what answers the question, and that is a clinical decision.
Is it caused by alcohol?
MASLD is defined as not being primarily alcohol-driven — that distinction is part of the definition, and separating the two is a clinical assessment. Alcohol nonetheless adds load to the same organ.
Is it reversible?
Liver fat is known to respond to changes in body weight and activity, and studies show it can fall substantially. How far that applies to a particular person, and at what stage, is a physician's assessment.
What is worth bringing to a physician?
Previous liver-enzyme results so the trend is visible, the accompanying glucose and lipid values, the weight and waist history, and an honest account of alcohol intake — that last one changes the assessment.