Fatty Liver - What are your Triggers?

Metabolic dysfunction-associated steatotic liver disease (MASLD), commonly known as “fatty liver,” now affects about 30% of adults in the United States. MASLD encompasses a broad spectrum of liver disease that can progress to cirrhosis, increasing the risk of hepatocellular carcinoma and premature mortality, and poses as a substantial public health burden. Sugary Drinks: A Major Culprit

One of the biggest offenders is sugar-sweetened beverages such as soda and fruit juice because of their high fructose content. Unlike glucose, fructose bypasses key insulin-regulated metabolic pathways, promoting insulin resistance. It also increases triglyceride production and contributes to hepatic inflammation through oxidative stress.  Importantly, naturally fructose-containing whole fruits such as mangos, grapes, and apples have not been associated with hepatic steatosis or MASLD development, likely because of their fiber and overall nutritional composition (for a guide to recommending fiber to patients, please see my May 2026 commentary). Therefore, consumption of whole fruits remains recommended despite its naturally occurring fructose content. The foods most likely to harm the liver are not necessarily the visibly “greasy” ones. Rather, they are often the excess sugar and ultraprocessed foods overrepresented in the modern American diet. Protecting the liver is less about avoiding fat altogether and more about reducing sugary beverages, limiting red and processed meat consumption, and adopting a Mediterranean-style diet centered on whole, minimally processed foods. Read more details here: https://www.medscape.com/viewarticle/foods-trigger-fatty-liver-hint-its-not-fat-2026a1000jbm?ecd=mkm_ret_260712_mscpmrk_gastro_perspectives_MAI_etid8495829&uac=234181DY&impID=8495829