A new study by Keck Medicine of USC has found that fatty liver disease, which many people consider minor or reversible can actually become life-threatening when combined with certain common health conditions. The research, published recently, reveals ‘metabolic risk factors’ raise the danger the most, offering important clues for millions living with fatty liver disease worldwide.
What is MASLD?
Doctors now use the term MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) instead of ‘non-alcoholic fatty liver disease’ or NAFLD. It happens when fat builds up inside the liver cells due to metabolic issues rather than alcohol consumption. Over time, this fatty buildup can cause inflammation, scarring, and even lead to liver failure or cancer.
MASLD usually doesn’t show symptoms early on. Many people discover it only during a routine blood test or ultrasound. It’s also closely linked with lifestyle and metabolic problems such as obesity, high blood pressure, high cholesterol, and Type 2 diabetes.
However, the USC study has now revealed that not all of these factors are equally dangerous. Some carry a much higher risk of death than others when they occur alongside MASLD.
High blood pressure
Most people think diabetes is the biggest concern when it comes to metabolic disease. But this new research has turned that idea upside down. According to the study findings, high blood pressure (hypertension) is actually the most dangerous companion to fatty liver disease.
The study found that people with MASLD and hypertension had about a 40 per cent higher risk of death compared to those with MASLD alone. This came as a surprise even to experts, since for years, most medical discussions around fatty liver disease have focused on controlling blood sugar or managing obesity.
“People underestimate how much damage high blood pressure can do when combined with fatty liver,” the researchers revealed. “It puts extra strain on blood vessels and organs, including the liver, that are already under stress.”
When your liver is already compromised, that additional vascular pressure can increase scarring (fibrosis) and worsen liver function. So, if you have fatty liver, your blood pressure control could be more important than you think.
Diabetes still a major risk factor
The second biggest danger is diabetes or prediabetes. The study revealed that having fatty liver plus elevated blood sugar levels or insulin resistance raises the risk of death by about 25 per cent.
High blood sugar can damage tiny blood vessels and lead to widespread inflammation. For someone with MASLD, that inflammation piles onto the existing liver stress, hastening disease progression.
Type 2 diabetes and MASLD also share a close relationship, each one makes the other worse. Poor glucose control increases fat buildup in the liver, while liver dysfunction in turn worsens insulin resistance. It becomes a vicious cycle that’s difficult to break without active management.
Doctors explain that early detection of diabetes or prediabetes, along with consistent monitoring, can make a big difference in outcomes for patients with fatty liver disease.
Low HDL cholesterol
While hypertension and diabetes grab most of the attention, the third standout danger is low HDL cholesterol, the so-called ‘good’ cholesterol.
The study found that people with MASLD and low HDL levels had about a 15 per cent higher risk of death than those with normal or high HDL.
HDL helps clear excess fat and cholesterol from the bloodstream and reduces inflammation. When HDL levels are too low, these protective benefits disappear, leaving the body more vulnerable to fat buildup and oxidative stress.
This finding is particularly important because cholesterol problems are common but often go unnoticed or untreated. For someone with fatty liver disease, maintaining a healthy lipid profile could be crucial to preventing severe complications.
The more risk factors, the higher the danger
The USC researchers also made another significant discovery, the risk compounds when multiple metabolic problems occur together.
Each additional metabolic condition (such as high blood pressure, diabetes, low HDL, or obesity) raises the overall risk of death by around 15 per cent.
So, for instance, a person with MASLD plus hypertension and diabetes faces a much higher risk than someone who only has one of those conditions. And if you add obesity to the mix, the risk climbs even higher.
This ‘stacking effect’ means that controlling even one or two risk factors can meaningfully improve survival chances.
Obesity and BMI still matter
While obesity is common among people with MASLD, the study noted that its impact varies depending on how high a person’s BMI (Body Mass Index) actually is.
People who are mildly overweight may not face as steep a risk increase as those with severe obesity. However, as BMI rises, so does the danger of complications and mortality.
This supports what experts have long said: losing even a modest amount of weight, about 5–10 per cent of your body weight, can significantly reduce fat in the liver and improve metabolic health overall.
What can you do if you have fatty liver?
Even if you are diagnosed with MASLD, then don’t worry as there are ways to manage it. As per the research, it can be managed and even reversed if caught early and treated with lifestyle changes. Doctors recommend keeping your blood pressure under control by monitoring it regularly, cutting down on salt, staying active, and taking prescribed medication consistently. It’s also important to manage blood sugar by avoiding refined carbs and sugary drinks, exercising regularly, and keeping track of fasting glucose or HbA1c levels. To improve cholesterol, focus on raising HDL (good cholesterol) through healthy fats like nuts, olive oil, and fatty fish, while avoiding trans fats and quitting smoking.
Maintaining a healthy weight is equally crucial, as even small reductions in body weight can significantly improve liver function and overall health. Doctors also advise not to skip routine check-ups, especially for those with hypertension, diabetes, or high cholesterol, and to get liver enzyme tests done regularly. Finally, it’s essential to treat lifestyle as medicine. Getting enough sleep, managing stress, and staying physically active can protect both the liver and the heart.
Fatty liver disease now affects nearly one in four adults worldwide, and its rates are climbing rapidly in India due to sedentary habits, poor diets, and obesity. While many still think of it as a minor condition, this new study proves it’s far from harmless.