NASH (nonalcoholic steatohepatitis) is treatable, and in many cases reversible, through a combination of weight loss, dietary changes, and in some cases medication. The condition, now also called MASH (metabolic dysfunction-associated steatohepatitis), involves fat buildup in the liver that has progressed to active inflammation and cell damage. Unlike simple fatty liver, NASH can scar the liver over time, so treatment focuses on reducing that inflammation and halting or reversing fibrosis before it becomes cirrhosis.
Weight Loss Is the Most Effective Treatment
Losing body weight remains the single most impactful intervention for NASH, and the benefits follow a dose-response pattern. Losing just 3 to 5 percent of your body weight reduces fat stored in the liver. Reaching 7 percent weight loss decreases liver inflammation as well. For someone who weighs 200 pounds, that translates to roughly 6 to 14 pounds. Greater weight loss, in the range of 10 percent or more, has been linked to actual regression of liver fibrosis in clinical studies, though that level of loss is harder to achieve and maintain through lifestyle changes alone.
The method of weight loss matters less than the result. Any sustainable approach that produces a caloric deficit will reduce liver fat. That said, the Mediterranean diet has the strongest clinical evidence behind it. In a systematic review and meta-analysis, people randomized to a Mediterranean-style eating pattern showed reductions in liver enzyme levels, fatty liver scores, and liver stiffness. The pattern emphasizes olive oil, fish, vegetables, legumes, nuts, and whole grains while limiting red meat, refined carbohydrates, and added sugars.
Exercise helps independently of weight loss. Regular physical activity, both aerobic and resistance training, reduces liver fat even when the number on the scale doesn’t change much. Aim for at least 150 minutes per week of moderate-intensity activity.
Alcohol and NASH
NASH is defined in part by the absence of significant alcohol use, but that doesn’t mean modest drinking is safe once you have the diagnosis. The clinical threshold used to distinguish NASH from alcohol-related liver disease is 21 drinks per week for men and 14 for women. Falling below that line qualifies the condition as “nonalcoholic,” but any alcohol adds metabolic stress to a liver already dealing with inflammation. Most hepatologists recommend eliminating alcohol entirely or reducing intake as much as possible.
The First FDA-Approved Medication
In 2024, the FDA approved resmetirom (brand name Rezdiffra), the first medication specifically indicated for NASH. It’s approved for adults with moderate to advanced liver scarring (stages F2 to F3 fibrosis) who do not yet have cirrhosis, and it’s meant to be used alongside diet and exercise, not as a replacement.
Resmetirom works by activating a thyroid hormone receptor that’s concentrated in the liver. Stimulating this receptor reduces the amount of fat stored in liver cells without significantly affecting thyroid hormone activity in the heart or bones. The dose is weight-based: 80 mg once daily for people under 220 pounds (100 kg), and 100 mg for those at or above that weight. It can be taken with or without food.
This medication represents a meaningful step forward, but it’s not a cure-all. It’s specifically for a defined window of disease severity, and long-term outcome data are still accumulating. Your doctor will use imaging or biopsy results to determine whether you fall within the approved fibrosis range.
Other Medications Under Use or Study
Before resmetirom’s approval, two off-label options were commonly used for NASH, particularly in people without diabetes. Vitamin E at 800 IU daily has been shown to improve liver inflammation and reduce fat in non-diabetic patients. Pioglitazone at 30 mg daily, a diabetes drug that improves insulin sensitivity, has similar benefits and can be used in NASH patients with or without diabetes. Both were studied in the landmark PIVENS trial. Vitamin E carries potential concerns with long-term use at high doses, so it’s typically reserved for patients with biopsy-confirmed NASH.
The injectable medications originally developed for type 2 diabetes and obesity are showing striking results for NASH. Tirzepatide, which targets two gut hormone receptors simultaneously, resolved NASH without worsening fibrosis in 44 to 62 percent of participants across dose groups in clinical trials, compared to just 10 percent with placebo. Around half of participants also saw at least a one-stage improvement in fibrosis. Semaglutide, a related drug targeting one of those same receptors, has shown similar promise, and the American Association for the Study of Liver Diseases updated its practice guidance in late 2025 to address semaglutide’s role in NASH treatment. These medications also produce significant weight loss, which likely accounts for a large share of their liver benefits.
Bariatric Surgery for Severe Cases
For people with obesity who haven’t achieved sufficient weight loss through other means, bariatric surgery can be remarkably effective at resolving NASH. In a long-term follow-up study, NASH resolved in 84 percent of patients within one year of surgery, and that resolution held at the five-year mark with no significant recurrence. Fibrosis improved in 70 percent of patients who had scarring at baseline, and fibrosis disappeared entirely in 56 percent. Even among patients who started with advanced bridging fibrosis (stage F3), nearly half saw it resolve completely.
These are some of the strongest outcomes in NASH treatment, but surgery carries its own risks and is reserved for patients who meet specific criteria for obesity severity and related health conditions.
Managing Heart Disease Risk
The leading cause of death in people with NASH is not liver failure. It’s cardiovascular disease. The same metabolic dysfunction driving fat into the liver, insulin resistance, inflammation, and abnormal cholesterol, also accelerates heart disease. This makes managing cardiovascular risk factors a core part of NASH treatment, not a side concern.
Statins, the most common cholesterol-lowering drugs, are safe for people with chronic liver disease including NASH, despite a lingering misconception that they harm the liver. The American Heart Association and American College of Cardiology recommend statin use in patients with chronic and stable liver disease. A large population-based study found that high-intensity statins were associated with a 17 percent lower risk of death from any cause and a 28 percent lower risk of liver-related death compared to lower-intensity statins in people with chronic liver disease. True statin-induced liver injury is exceptionally rare, and the benefits clearly outweigh the risks for most patients.
Monitoring Your Liver Over Time
NASH treatment isn’t a one-and-done process. Your liver’s response to weight loss, medication, or other interventions needs to be tracked over time. Non-invasive tests have largely replaced the need for repeat liver biopsies in routine monitoring. The two most common are vibration-controlled transient elastography (often called FibroScan) and magnetic resonance elastography, both of which measure liver stiffness as a proxy for fibrosis severity. Blood-based scoring systems that combine standard lab values can also help track trends.
Guidelines from the American Gastroenterological Association recommend serial monitoring with these tools, particularly for patients with advanced fibrosis (stages F3 and F4), because liver stiffness correlates with the risk of developing serious complications like portal hypertension. No specific interval is mandated, but most clinicians reassess every 6 to 12 months depending on disease severity and whether treatment has recently changed. These measurements help determine whether your fibrosis is stable, improving, or progressing, which directly shapes decisions about escalating or adjusting treatment.