Diet and Lifestyle for Fatty Liver (MASLD)

Movement, sleep and routine are as important as the food list.

• Aim for at least 150 minutes a week of moderate activity (brisk walking, cycling, swimming), spread over most days, plus muscle-strengthening exercise twice a week. Exercise reduces liver fat even if your weight does not change.
• Aim to lose weight gradually: about 0.5 kg a week, reaching 5 to 10 percent of body weight over 6 to 12 months, then keep it off. Avoid crash diets.
• Limit sitting time; walk after meals; take the stairs. In hot weather exercise early morning or evening, or indoors.
• Sleep 7 to 8 hours and treat sleep apnoea (snoring with daytime sleepiness) if present; do not smoke.
• Control blood sugar, blood pressure and cholesterol with your doctor; take prescribed medicines.

No single “fatty liver diet” is magic. What matters is a pattern you can keep for years, with fewer calories if you carry excess weight. Evidence strength is stated.

• Mediterranean-style pattern, strong evidence: vegetables and fruit, legumes, whole grains, fish, nuts, olive oil as the main fat, moderate dairy such as laban and yoghurt, and less red and processed meat. It lowers liver fat even without weight loss.
• Cut sugary drinks and juice, strong evidence: soft drinks, energy drinks, sweet tea or coffee with several spoons of sugar, flavoured milk, and juice. Fructose-sweetened drinks are linked with more liver fat. Choose water, unsweetened tea or coffee, or plain laban (unsweetened, not salted heavily).
• Reduce ultra-processed food and refined carbohydrates, good evidence: white bread, pastries, sweets, biscuits, crisps, fast food, instant noodles and ready meals. Choose whole grains, brown or basmati rice in measured portions, and legumes.
• Healthy fats: use olive oil, nuts, seeds and oily fish (sardines, mackerel, salmon) twice a week; limit ghee, butter, fried food, palm oil and fatty meats. Fat quality matters more than a very low-fat diet.
• Coffee, observational evidence: plain coffee without added sugar, about 2 to 3 cups a day, is associated with less liver scarring and lower liver-cancer risk. Studies mostly used filtered or brewed coffee, so the effect of Arabic coffee (qahwa) with cardamom is unproven; avoid adding sugar, syrup or many dates. Do not drink more coffee if you have palpitations, poor sleep, reflux, pregnancy or advice against it.
• Alcohol: the safest advice for MASLD is to avoid alcohol or keep it to the minimum; with advanced scarring (fibrosis or cirrhosis), do not drink at all. Alcohol and fatty liver damage the liver together.
• Dates and fruit: whole fruit is fine and better than juice. Dates are healthy but very sugar-dense; a few (for example 3) at a time, not a whole box, and count them in your daily sugar, especially if you have diabetes.
• Fasting and special diets: intermittent fasting and time-restricted eating can help you eat less, but they are not proven better than ordinary calorie reduction; do not use fasting to justify heavy, sugary or fried meals when you eat. Very low-calorie diets and ketogenic diets should only be used under medical supervision, especially if you take diabetes medicines.
• Supplements: do not rely on herbal “liver cleanses”, green tea extract, or slimming products. Vitamin E is only for selected patients on specialist advice; omega-3 fish oil and probiotics lack firm evidence for treating MASLD.

There is no one tablet that treats all MASLD. Medicines treat the conditions around it and, in selected patients with scarring, the liver itself. See the Fatty liver disease page for detail.

• Treat diabetes, blood pressure and cholesterol; statins are safe in fatty liver and protect the heart.
• Some diabetes and weight-loss medicines (GLP-1 receptor agonists) help weight and liver fat, and one is approved in some countries for MASH with moderate to advanced scarring; your doctor decides who may benefit.
• Resmetirom, a liver-targeted medicine, is approved in some countries for MASH with scarring; availability in Saudi Arabia may differ, so ask your hepatologist.
• Tell your doctor about all herbal products and supplements; avoid unregulated slimming products.
• Avoid alcohol with medicines such as paracetamol in high doses.

Procedures are used for staging the liver or for obesity not controlled by lifestyle and medicines.

• FibroScan or a blood fibrosis score measures scarring; liver biopsy is reserved for uncertain cases.
• Bariatric (weight-loss) surgery or endoscopic procedures can markedly reduce liver fat and inflammation in suitable people with obesity; they need long-term dietary follow-up.
• People with cirrhosis need ultrasound surveillance for liver cancer every 6 months and endoscopy to check for varices when advised.