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Most firefighters haven’t heard of MASLD, but it’s time they did. Previously known as NAFLD (non-alcoholic fatty liver disease), MASLD, short for metabolic dysfunction–associated steatotic liver disease, reflects the real culprit: metabolic issues like insulin resistance, not alcohol1. Likewise, NASH has been renamed MASH (metabolic dysfunction–associated steatohepatitis) to highlight its inflammatory, progressive nature1.
These terms aren’t just medical jargon—this disease often flies under the radar, quietly causing fat buildup in the liver that can escalate to inflammation, scarring, and even liver failure. In one study of Texas firefighters, nearly 42% were at risk for MASLD, and 30% already showed signs of liver damage, even with no obvious symptoms2. With obesity, high blood pressure, and blood sugar issues running rampant in the fire service, this is one more job hazard that firefighters can’t ignore.
The real danger? MASH and MASLD rarely wave red flags. They’re usually found on an ultrasound, often by accident1. When symptoms do show up, they’re vague: fatigue, belly discomfort, weight loss, or just feeling off1. That’s why early detection is key. If your department offers full-body ultrasound scans, don’t brush it off—get checked, even if you feel fine. Catching liver issues early could keep you off disability, out of the hospital, and in control of your health.
For firefighters with fatty liver disease, one of the most effective strategies is modest, sustained weight loss. No, this isn’t the crash diet 2 weeks before a cruise, this is a slow loss, ideally through reducing daily calorie intake by about 500–1000 calories Rapid weight loss may worsen symptoms of MAFLD, so low and slow is the way to go3. Even a 5–10% reduction in body weight can significantly decrease liver fat, inflammation, and fibrosis risk3. In the fire service, where meals are often large and snacks are constant, this doesn’t mean going hungry—it means being strategic: skip second portions, watch liquid calories, and build meals around veggies and lean protein to reduce overall intake without sacrificing satisfaction.
Swapping out the type of fat you eat can make a big difference for liver health, especially if you’re dealing with MASLD. According to Kargulewicz et al. (2014), reducing saturated fat intake (such as fatty meats, butter, and full-fat dairy) and replacing it with unsaturated fats can help decrease liver fat and improve metabolic function3. That means choosing olive oil instead of butter, snacking on nuts instead of chips, and adding fatty fish like salmon in place of sausage or bacon. These unsaturated fats, especially omega-3 fatty acids, have anti-inflammatory effects that can support liver repair and help lower triglyceride levels. Swapping your fat choices can also positively impact your cholesterol (more on that here https://pbgfrwellness.com/improve-your-cholesterol-with-this-simple-swap/)
While most firefighters associate liver damage with alcohol, excess sugar, especially from sodas, energy drinks, and ultra-processed foods, is a major driver of fat buildup in the liver4,5. Fructose, found in sweetened drinks and snacks, is directly processed by the liver and can rapidly contribute to steatosis (fatty liver disease). A major review even found that just moderate amounts of added sugar can double liver fat synthesis4. Added sugars in beverages is of particular concern. In a large Chinese cohort, higher intake of total and liquid added sugars raised the risk of NAFLD by about 18–20%, while sugar in solid foods didn’t show the same risk5. Bottom line: cut back on sugary drinks to protect your liver.
According to the review by Polyzos et al., alcohol intake, even in moderate amounts, can significantly impact the progression of non-alcoholic fatty liver disease (NAFLD, now MASLD)6. While the absence of heavy drinking technically defines the disease, the line between “safe” and “harmful” drinking is blurry.
The paper highlights that even low-to-moderate alcohol consumption (e.g., a few drinks per week) may increase the risk of liver inflammation, fibrosis, and progression to MASH6. It also notes that individuals with metabolic risk factors, like many firefighters, may be especially vulnerable to alcohol-related liver damage, even at lower doses. The takeaway? If you’ve got signs of fatty liver or metabolic dysfunction, cutting back or cutting out alcohol isn’t just smart; it’s protective6.
Liver disease is a growing but often overlooked threat in the fire service. MASLD and MASH can develop silently, but the right nutrition changes, such as cutting added sugar, reducing alcohol, and replacing unhealthy fats with healthy ones, can have a significant impact. You don’t need a perfect diet! Small changes at the kitchen table can pay off big on the job and in retirement.
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