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Home Offer Syndromes Fatty liver disease (MAFLD, MASLD, NAFLD)

Understanding metabolic fatty liver disease

MAFLD (Metabolically Associated Fatty Liver Disease) and NAFLD (Non-Alcoholic Fatty Liver Disease) are two terms that refer to fatty liver disease, but are associated with different diagnostic criteria and concepts. Here are the main differences:

Diagnostic criteria:

  • NAFLD: The diagnosis of NAFLD is based on the exclusion of other causes of fatty liver, particularly excessive alcohol consumption. It refers to a fatty liver that is not caused by alcohol.

  • MAFLD: In contrast, MAFLD emphasizes the association with metabolic disorders (e.g. obesity and metabolic risk factors). To be diagnosed as MAFLD, metabolic risk factors such as obesity, diabetes or insulin resistance must be present. MAFLD is a disease in which excessive fat accumulates in the liver, mainly due to metabolic disorders. Factors such as malnutrition, lack of physical activity and insulin resistance can contribute to this disease.

Symptoms of MAFLD:

  • Fatigue
  • Upper abdominal pain
  • Weight gain
  • Yellowing of the skin (as the disease progresses)

When to seek medical help? Seek medical attention if you notice symptoms of MAFLD or have already been diagnosed. A doctor can provide specific recommendations and treatment options based on your individual situation.

Weight loss for non-alcoholic fatty liver disease (MASLD)

Gentle, effective therapy for fatty liver - at Vivomed in Bern
Non-alcoholic fatty liver disease, now correctly referred to as MASLD (Metabolic Dysfunction Associated Steatotic Liver Disease), is the most common liver disease worldwide. It is also increasing significantly in Switzerland. The main causes are overweight (obesity), lack of exercise and type 2 diabetes mellitus.

At Vivomed - Gastroenterology Bern, we provide you with individual and evidence-based support in the treatment of fatty liver - with the aim of protecting your liver in the long term and preventing secondary diseases.

Knowledge strengthens: myths about fatty liver.

Is diet really that important for fatty liver?

Yes, diet is the central therapeutic pillar in MASLD. Despite modern drug developments, lifestyle and dietary changes remain the most effective measures to reduce liver fat, inhibit inflammation and prevent disease progression.

However, there are many dietary myths circulating that can confuse or even harm patients. Current scientific reviews clearly show which recommendations are sensible - and which are not.

Are carbohydrates generally bad for the liver?

No. Complex carbohydrates from wholegrain products, vegetables and fruit tend to have a protective effect. Simple sugars, especially fructose from soft drinks, fruit juices and highly processed foods, are particularly problematic.

Should fat be avoided completely?

No. The quality of the fats is crucial. Unsaturated fatty acids from olive oil, nuts, avocados or oily fish have anti-inflammatory and liver-protective effects. Trans fats and an excess of saturated fats, on the other hand, should be reduced.

Is it only the calories that count?

No. Studies show that the composition of the diet plays a key role. A Mediterranean diet can improve liver health - even without significant weight loss. A diet high in fructose and saturated fat, on the other hand, has a detrimental effect on the liver, even with the same calorie intake.

Is even a small weight loss enough?

Partially. A weight reduction of just 3-5% can reduce fatty liver disease. However, 7-10% is necessary for a significant improvement in inflammation and fibrosis. Slow, sustained weight loss that reduces fat and preserves muscle mass is important.

Can slim people also have a fatty liver?

Yes, around 20% of those affected are of normal weight ("lean MASLD"). The causes can be visceral fat, genetic factors or impaired mitochondrial function. The same nutritional principles therefore also apply to normal weight.

Is intermittent fasting harmful?

No. When used correctly (e.g. 16:8 method), intermittent fasting can reduce liver fat and improve insulin sensitivity. However, it is not superior to other sustainable forms of nutrition.

Do superfoods or dietary supplements help?

No - there are no miracle cures. Substances such as vitamin E, omega-3 fatty acids or coffee can have a supportive effect, but are no substitute for a comprehensive diet and lifestyle change.

Are herbal teas and "liver detoxes" harmless?

No. Many herbal preparations can be toxic to the liver, including high-dose green tea, kava kava or turmeric. They should only be taken after consulting a doctor.

Is coffee allowed?

Yes. 2-3 cups of black filter coffee per day have been proven to protect the liver - without sugar, milk or vegetable creams.

Should iron be avoided if ferritin is elevated?

Usually no. Elevated ferritin is often an expression of inflammation or insulin resistance. Iron reduction is only necessary if hereditary haemochromatosis is confirmed.

Can you eat red meat?

Only to a limited extent. Highly processed red meat or red meat cooked at high temperatures in particular is associated with a worsening of liver disease. We recommend a maximum of two portions per week, lean and gently cooked. Plant-based proteins and omega-3-rich fish are beneficial alternatives.

Should gluten or lactose be avoided?

Only if you have a proven intolerance. An unjustified avoidance can lead to malnutrition and has no proven benefit for the liver.

Is occasional alcohol allowed?

No. Even small amounts of alcohol can cause additional damage to the liver. The clear recommendation for MASLD is complete abstinence from alcohol.

Lifestyle change - the most important therapy

The basis of fatty liver treatment is a sustainable change in lifestyle. The following have proven effective

Diet

  • Calorie reduction with a balanced intake of nutrients
  • Mediterranean diet (lots of vegetables, fruit, whole grains, fish, olive oil)
  • Avoidance of highly processed foods
  • Reduction of sugary drinks and soft drinks

Exercise

  • Regular physical activity (e.g. brisk walking, cycling)
  • Endurance and strength training are both effective
  • Exercise without weight loss can also reduce liver fat content

These measures not only lower liver fat, but also reduce the risk of liver cirrhosis and liver cancer.

Medication and surgical options

If lifestyle measures alone are not sufficient, other therapies may be considered in individual cases:

  • GLP-1 receptor agonists (e.g. semaglutide), especially for obesity or diabetes
  • Endobariatry (gastric balloon, endoscopic stomach reduction)
  • Bariatric (metabolic) surgery for severe obesity

These options are effective, but are associated with higher costs and possible risks and are carefully assessed on an individual basis.

Individually tailored therapy at Vivomed - Gastroenterology Bern

Successful treatment of fatty liver requires an individually tailored strategy based on scientific findings. Myths and blanket diets jeopardize the success of therapy.

At Vivomed - Gastroenterology Bern, we offer a comprehensive assessment, modern diagnostics and personal advice for patients from Bern and the whole of German-speaking Switzerland. The aim is to protect your liver in the long term and prevent consequential damage.

Do you have any questions about fatty liver or would you like a specialized assessment?
Contact our team - we will advise you competently and individually.

Vivomed - Gastroenterology Bern
Your specialist practice for liver and intestinal diseases

Scientific basis & sources

  1. Rinella et al, Hepatology 2023 - new nomenclature MASLD
    DGVS S2k guideline NAFLD/MASLD 2022
  2. Koutoukidis et al, Metabolism 2021 - Weight loss and liver health
  3. Vilar-Gomez et al, Gastroenterology 2015 - Lifestyle intervention for MASH
  4. Newsome et al, NEJM 2021 - GLP-1 analogs for fatty liver
  5. Keating et al, Journal of Hepatology 2012 - Exercise and fatty liver