95 Million Americans Could Have This Disease and Not Know It
You might feel no pain, be in great shape, and see nothing unusual on your routine lab test... and still be at risk for this silent disease.
That's because fat could be building up in one of the hardest-working organs in your body: the liver.
Roughly 1 in 3 U.S. adults – more than 100 million Americans – now has a condition called metabolic dysfunction-associated steatotic liver disease ("MASLD"). It's the newer name for nonalcoholic fatty liver disease.
Some estimates say more than 95% of those folks don't even know they have it.
Too much fat in the liver can eventually trigger inflammation and scarring (or fibrosis). And in some people, that progresses to severe scarring (cirrhosis), liver failure, or even liver cancer.
What's more, we're learning that figuring out who's at risk isn't always as simple as looking at the waistline... or measuring liver-enzyme levels.
Today, let's clear up some of the misconceptions that could allow fatty liver disease to slip under your radar. And I'll also show you some simple ways to help protect your liver.
Three Myths About Fatty Liver Disease
Myth No. 1: "I'd know if something was wrong with my liver."
MASLD is often called a "silent" disease because most folks don't notice the symptoms early on. Even bloodwork isn't exactly foolproof... It's estimated that up to half of people with fatty liver disease still have normal liver-enzyme levels.
That's why doctors are focusing more on risk factors... For example, there's the Fibrosis-4 (or FIB-4) score which estimates your liver-disease risk by combining your age with three common blood-test results for measuring liver health.
If you have conditions like Type 2 diabetes, prediabetes, abnormal cholesterol or triglycerides, high blood pressure, or excess weight around your middle, ask your doctor whether you should be screened.
Myth No. 2: "I'm thin, so I don't have to worry."
While extra weight – especially around the abdomen – does raise your risk, you could still be at risk even if you're thin.
An estimated 6.4% of lean U.S. adults have MASLD, which represents roughly 3.8 million Americans. And get this: More than a third of those cases had never been diagnosed. Plus, among lean adults with diabetes, the MASLD prevalence climbed to 33%.
And being young doesn't entirely give your liver a free pass, either...
Last week, the University of California San Diego School of Medicine published the first-ever study on MASLD-caused cirrhosis in younger adults.
It looked at roughly 2,400 adults with MASLD confirmed via biopsy. About a quarter of the participants who had already developed cirrhosis did so before age 50. Researchers found that genetics and Type 2 diabetes were important risk factors.
Myth No. 3: "Once fat gets into my liver, the damage is done."
Thankfully, your liver happens to be pretty resilient. Lifestyle changes can reduce liver fat before damage really starts to set in.
You may not need to chase the "perfect" diet, either... A 2026 randomized trial followed 173 adults with MASLD who were overweight or obese for six months. Researchers found two factors that independently predicted improvements in liver fat: losing excess weight and eating fewer ultraprocessed foods.
Do what I do and feast on plenty of vegetables, fruits, nuts, whole grains, fish, and healthy fats like extra-virgin olive oil... while also eliminating sugary drinks, refined carbs, and processed meats.
And don't forget about movement – specifically, one kind...
A new meta-analysis of 11 randomized trials with 395 participants found that resistance training improved liver-enzyme levels and reduced liver fat. I recommend mixing muscle-challenging workouts like bodyweight exercises and using resistance bands with regular cardio like biking.
Fatty liver disease may be common... But it's not inevitable. Nor is it a life sentence. You can still do a lot about it before any permanent damage happens.
And making simple changes like these isn't just good for your liver... Did you know that nearly half of dementia cases can be delayed or even prevented? In my brand-new book, Power Up Your Brain!, I revealed 23 simple, research-backed tweaks you can make today to keep your brain healthy as you age. You can check out the book right here.
What We're Reading...
- Something different: Meet the brand-new cat species.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
September 24, 2026