Fatty Liver — The Hidden Disease of Modern Diets

Non-alcoholic fatty liver disease (NAFLD), recently renamed metabolic-dysfunction-associated steatotic liver disease (MASLD), is the build-up of fat in liver cells in people who drink little or no alcohol. It used to be rare. Today, conservative estimates put global prevalence at 32% of adults — and rising fastest in countries newly adopting Western diets. A meaningful fraction of these cases progress to steatohepatitis, fibrosis, cirrhosis, liver cancer or liver failure. NAFLD has become the leading cause of liver transplantation in many countries.

The drivers are well understood: excess calories from refined carbohydrates and added sugars (particularly fructose from sugar-sweetened drinks), saturated fat from animal products, and visceral adiposity. The liver, asked to package and store more fat than it can metabolise, begins storing it inside its own cells.

Two dietary patterns drive hepatic fat accumulation. The first is excess fructose, particularly in liquid form, which the liver converts directly into fat. The second is dietary saturated fat, which is preferentially packaged into liver triglycerides rather than burned. Animal products are the leading dietary source of saturated fat in most Western diets.

Whole-food plant-based diets address both. They are naturally low in saturated fat. They contain essentially zero added sugar in their unprocessed form. They are rich in soluble fibre — which improves insulin sensitivity, the upstream driver of fatty liver — and in polyphenols that directly reduce hepatic inflammation. Multiple randomised trials now show hepatic fat reductions of 30–50% within 8–12 weeks on whole-food plant patterns.