Fatty Liver (MASLD/MASH): Diagnosis, FIB-4 Score, Treatment Ladder & Supplement Evidence 2026
OneDayMD Research Team • Updated October 2026 A practical guide to metabolic dysfunction-associated steatotic liver disease: how to recognize fatty liver, estimate fibrosis risk with FIB-4, decide when FibroScan or specialist assessment is needed, and understand what actually works in 2026. The key idea: fatty liver is not simply a problem of “too much fat in the liver.” The clinically important question is whether there is inflammation and, especially, significant liver fibrosis . That changes the level of risk and the treatment conversation. OneDayMD bottom line: For most adults with suspected MASLD, the practical pathway is identify metabolic risk → calculate FIB-4 → use a second non-invasive test when indicated → stage fibrosis → treat weight, glucose, lipids and cardiovascular risk → consider MASH-targeted medication when significant fibrosis is present . Supplements remain secondary because guideline-level evidence is not strong enough to recom...