AI Summary: Lifestyle change is the cornerstone of MASLD treatment, while the medicine resmetirom is FDA-approved for MASH with moderate-to-advanced fibrosis that has not reached cirrhosis.
Source: Consumer Factpack, August 28, 2026
MASLD and MASH Treatments: Lifestyle Changes, Therapies & Care Options
Medically Reviewed. Last updated on July 13, 2026.
MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic dysfunction-associated steatohepatitis) treatment focuses on addressing the underlying metabolic factors — such as obesity, insulin resistance, and elevated cholesterol — that contribute to liver disease. Care for these conditions typically combines lifestyle changes, weight management, medications, and ongoing monitoring to support liver health and manage disease progression. Because MASLD and MASH vary in severity from person to person, treatment plans are personalized based on disease stage, overall health, and individual needs.
On this page, you can explore the main treatment options for MASLD and MASH and learn how different therapies may support liver health. It introduces detailed treatment topics, including specific therapies such as GLP-1 and incretin-based treatments, to help you understand how they fit into a broader care plan. If you need personalized guidance, you can connect with a liver specialist for ongoing care and treatment decisions suited to your situation.
Aimy answers from LiverDirectory’s reviewed health information — helping patients make sense of liver-health terms, prepare for specialist visits, and explore what to look up next.
Treatment for MASLD and MASH starts with lifestyle change. Medicines and procedures can add to it by supporting weight loss, metabolic health, and, in some cases, the liver itself. These therapies target the metabolic factors that drive liver fat, inflammation, and scarring.
Explore the four treatment groups below. Which one applies depends on your disease stage, your weight, and your overall health. Your care team will consider all three when building your plan.
GLP-1 / Incretin-Based Therapy
GLP-1 / incretin-based therapies were developed for type 2 diabetes and weight management. They support weight loss, blood sugar control, and overall metabolic health, and they are being studied for MASLD and MASH. Options include semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro, Zepbound), and liraglutide (Victoza, Saxenda). In a clinical trial of adults with MASH and moderate-to-advanced fibrosis, weekly semaglutide resolved steatohepatitis in more people than placebo.
THR-β agonist therapy is a liver-directed treatment for MASH. Resmetirom (Rezdiffra) is a once-daily tablet that acts on thyroid hormone receptor-beta in the liver. It is FDA-approved for non-cirrhotic MASH with moderate-to-advanced fibrosis (F2–F3) and is used together with a healthy diet, regular activity, and weight management.
Additional metabolic therapies are medicines and supplements used alongside primary MASLD and MASH care. They help manage metabolic risk factors such as blood sugar and insulin resistance. This group includes pioglitazone (Actos), vitamin E, and SGLT2 inhibitors: Jardiance, Farxiga/Forxiga, Invokana, and Steglatro. Whether any of these fits depends on your diagnosis and your other health conditions.
Bariatric surgery and endoscopic sleeve gastroplasty (ESG) reduce stomach capacity to promote substantial, lasting weight loss. In selected people with obesity, they may reduce liver fat and improve or slow MASLD and MASH. Bariatric surgery requires a medical, nutritional, and psychological evaluation beforehand and lifelong follow-up afterward.
How Lifestyle Changes and Nutrition Support MASLD/MASH Management
Lifestyle changes are an important part of managing MASLD and MASH. Nutrition, physical activity, weight management, and other healthy habits may help support liver health and address the metabolic factors linked to these conditions. Explore the topics below to learn more.
Liver-Friendly Eating Pattern
A Mediterranean-style diet is the most studied eating pattern for fatty liver. It emphasizes healthy fats, such as monounsaturated and omega-3 fats, and limits refined carbohydrates and processed foods. A plan works best when it fits your culture, budget, and daily life.
Weight Management and MASLD/MASH
Losing at least 5% of your body weight can reduce liver fat. About 7% to 10% is typically needed to resolve MASH inflammation, and more than 10% has been shown to help improve fibrosis. Gradual weight loss is a common first step.
Exercise and Physical Activity for Liver Health
Many studies show benefit from about 150 minutes a week of moderate aerobic activity, plus resistance exercise two to three times a week. Regular activity can lower liver fat and improve insulin sensitivity. If you are new to exercise, build up slowly.
Alcohol and Supplements
Ideally, avoid alcohol completely. Even mild to moderate drinking in people with fatty liver has been linked to a higher risk of steatohepatitis, fibrosis, and liver cancer. Most supplements are not proven to help and some can cause harm, so ask your provider before taking any.
Connect With a Liver Specialist for Guidance on MASLD Treatment, MASH Management, Nutrition, and Long-Term Liver Health.
TREATMENT GOALS BY DISEASE STAGE
Treatment Goals and Approaches by Disease Stage
The goal of treatment depends on how far the liver disease has progressed. For early MASLD, the goal is to reduce liver fat. For MASH, it is to calm inflammation and prevent or slow scarring.
The summaries below are general. Your healthcare provider will decide which approach fits your diagnosis, liver health, and medical history.
MASLD: Lifestyle Change Comes First
Early MASLD often causes no symptoms. Lifestyle change is the cornerstone of care: more physical activity, a healthier diet, and weight loss. Early fatty liver can often be reversed with sustained weight loss. No medicine is currently approved for MASLD without steatohepatitis or significant fibrosis, though several are in late-stage clinical trials.
MASH: Calming Inflammation and Managing Related Conditions
MASH is a more serious form of MASLD. Fat buildup leads to inflammation, then to tissue damage and scarring (fibrosis). Weight loss of about 7% to 10% is typically needed to resolve the inflammation. Care also includes managing related conditions such as type 2 diabetes, high cholesterol, and high blood pressure. Statins, used for high cholesterol, are considered safe in MASLD and MASH. Your provider will decide what fits you.
MASH With Moderate-to-Advanced Fibrosis: Medicine Can Be Added
Resmetirom (Rezdiffra) is FDA-approved for MASH with moderate-to-advanced fibrosis (stages F2 to F3) that has not progressed to cirrhosis. It is used together with diet, activity, and weight management. Semaglutide, a GLP-1 medicine, has also been studied in this group. In a large trial, more people taking it had their MASH resolve and their fibrosis improve than people taking placebo. Weight loss above 10% has also been shown to help improve fibrosis.
Cirrhosis: Closer Follow-Up
Resmetirom has not been shown to be safe or effective for cirrhosis (F4 fibrosis). People with MASLD-related cirrhosis need the closest follow-up. This includes liver cancer screening with an abdominal ultrasound and an alpha-fetoprotein blood test, often every 6 months. Your specialist will tailor care to your situation.
Regular monitoring helps your healthcare provider see how your liver is responding to treatment and catch changes early. Depending on your disease stage and treatment plan, follow-up can include blood tests, liver imaging, fibrosis assessments, and sometimes a biopsy.
Blood Tests
Liver enzyme tests show how your liver is responding. Cholesterol and blood sugar tests track the metabolic conditions linked to MASLD and MASH. Some medicines call for regular liver function and cholesterol checks.
FibroScan is a quick, painless test that estimates liver fat and stiffness, a sign of scarring. It can be repeated over time without surgery. MRI-based tests can also measure liver fat.
A tissue sample examined under a microscope. Providers use it occasionally, such as when imaging results are unclear or another cause of liver disease is suspected.
Follow-up depends on scarring. With no sign of fibrosis, checks every 2 to 3 years with non-invasive tests may be enough if your metabolic risks stay stable. With significant fibrosis, checks are usually yearly. With cirrhosis, checks and liver cancer screening happen about every 6 months.
Early MASLD can often be reversed. Sustained weight loss, a balanced diet, and regular exercise can reduce liver fat, and controlling related conditions such as diabetes and high cholesterol also helps. Once scarring (fibrosis) develops, reversal becomes harder, which is why early action and monitoring matter. No medicine is currently approved for MASLD without steatohepatitis or significant fibrosis, so lifestyle change remains the main treatment. Your healthcare provider can help you build a plan that fits your stage.
Can MASH improve with medicine or lifestyle treatment?
Yes, MASH can improve. In a large trial of adults with MASH and moderate-to-advanced fibrosis, weekly semaglutide resolved steatohepatitis in 62.9% of people, compared with 34.3% on placebo. Fibrosis improved by at least one stage in 36.8% of treated people, compared with 22.4% on placebo. Lifestyle change can also calm MASH inflammation. Results vary from person to person, so your specialist can explain which combination of lifestyle change and medicine fits your situation.
Which medicines are used to treat MASH?
Several medicines are used or studied for MASH. Resmetirom (Rezdiffra) is FDA-approved for MASH with moderate-to-advanced fibrosis (F2 to F3) that has not reached cirrhosis. GLP-1 medicines such as semaglutide support weight loss and have been studied in MASH. Other metabolic medicines, including pioglitazone, vitamin E, and SGLT2 inhibitors, may be considered depending on your health. Medicine works alongside lifestyle change, and your provider will match any choice to your disease stage.
How much weight loss helps the liver?
Losing at least 5% of your body weight can reduce liver fat. About 7% to 10% is typically needed to resolve MASH inflammation, and more than 10% has been shown to help improve fibrosis. In one semaglutide trial, participants lost about 10.5% of their body weight on average. Gradual loss through diet, exercise, and, when appropriate, medicine or bariatric surgery is a common approach. Your provider can help you set a realistic goal.
What are the side effects of MASH medicines?
Side effects depend on the medicine. GLP-1 medicines most often cause nausea, diarrhea, constipation, or vomiting, usually mild to moderate. Resmetirom can cause diarrhea and nausea early in treatment, along with itching and dizziness, and liver enzymes are checked regularly because significant rises, though rare, can occur. Other metabolic medicines carry their own risks. Review the full risks and benefits of any medicine with your healthcare provider before you start.
Does diet improve fatty liver disease?
Yes, diet is a major part of treatment. A Mediterranean-style pattern, which favors healthy fats such as monounsaturated and omega-3 fats and limits refined carbohydrates and processed foods, is the most studied approach. Ideally, avoid alcohol, and ask your provider before taking supplements, since most are unproven and some can cause harm. Diet works best with regular physical activity and gradual weight loss. A registered dietitian or liver specialist can build a plan that fits you.
Is bariatric surgery an option for MASLD or MASH?
It can be, for some people. Bariatric surgery, such as sleeve gastrectomy or gastric bypass, reduces stomach capacity and promotes substantial, lasting weight loss, which may reduce liver fat and improve or slow MASLD and MASH. It requires a medical, nutritional, and psychological evaluation first, plus lifelong dietary changes and follow-up afterward. You must meet eligibility criteria and be medically appropriate for the procedure. Ask your healthcare provider whether you may be a candidate.
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Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
