Fatty liver disease affects approximately one in three UK adults, with dietary factors playing a crucial role in its development and progression. Whilst sugar and fat intake have long been recognised as key contributors, emerging research suggests that salt consumption may also influence liver health through metabolic and inflammatory pathways. Understanding whether salt is bad for fatty liver requires examining the evidence linking sodium intake to hepatic steatosis, alongside broader dietary strategies for managing this increasingly common condition. This article explores the relationship between salt and fatty liver disease, providing evidence-based guidance for patients seeking to optimise their liver health through dietary modification.

Understanding Fatty Liver Disease and Dietary Factors

Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells—specifically, when at least 5% of hepatocytes (liver cells) contain fat droplets. This condition affects up to around one in three adults in the UK and exists in two main forms: non-alcoholic fatty liver disease (NAFLD), which develops in people who drink little or no alcohol, and alcohol-related liver disease (ARLD), caused by excessive alcohol consumption. NAFLD has become increasingly prevalent alongside rising rates of obesity, type 2 diabetes, and metabolic syndrome. (Healthcare professionals may also encounter the emerging term metabolic dysfunction-associated steatotic liver disease, or MASLD, in recent literature.)

The liver plays a crucial role in metabolising nutrients, filtering toxins, and regulating metabolism. When fat accumulates beyond this threshold, simple steatosis may progress to non-alcoholic steatohepatitis (NASH), characterised by inflammation and potential scarring. Left unmanaged, this may advance to cirrhosis or liver failure. Risk factors include obesity (particularly central adiposity), insulin resistance, high cholesterol, hypertension, and poor dietary habits. For people of South Asian, Chinese, Japanese, or other Asian ethnicity, lower waist circumference thresholds apply (≥90 cm for men, ≥80 cm for women).

Dietary factors significantly influence fatty liver development and progression. Excessive consumption of refined carbohydrates, added sugars (especially fructose), saturated fats, and ultra-processed foods contributes to hepatic fat accumulation. The liver converts excess dietary sugars and calories into triglycerides, which are then stored in liver cells. Conversely, a balanced diet rich in whole foods, fibre, lean proteins, and healthy fats can help reduce liver fat and inflammation.

Whilst much attention focuses on sugar and fat intake, emerging evidence—largely from observational and animal studies—suggests that sodium consumption may also play a role in fatty liver disease progression. Understanding how various dietary components, including salt, may affect liver health enables patients to make informed choices about their nutrition and overall metabolic wellbeing.

How Salt Affects Fatty Liver Disease

Research into the relationship between salt intake and fatty liver disease has revealed several potential mechanisms, though the evidence base continues to evolve and is predominantly observational or derived from animal models. Higher sodium consumption has been associated with metabolic dysfunction linked to NAFLD through multiple pathways. Observational studies have found associations between higher salt intake and increased prevalence of NAFLD, independent of other risk factors such as obesity and diabetes. Animal studies suggest that excessive salt intake may promote insulin resistance—a key driver of hepatic fat accumulation—though robust human dose–response evidence remains limited.

Sodium may also contribute to oxidative stress and inflammation within liver tissue. Animal research has shown that high-salt diets can activate inflammatory pathways and increase production of reactive oxygen species, which damage hepatocytes and may promote fibrosis. Whilst human studies are less conclusive, these mechanisms warrant further investigation. Emerging research also suggests that salt consumption may influence the gut microbiome, potentially altering the gut–liver axis—the bidirectional communication system between intestinal bacteria and the liver that influences metabolic health—though this evidence is preliminary in humans.

Furthermore, salt consumption influences blood pressure and cardiovascular health, both intimately connected to liver disease. Hypertension is common in people with NAFLD and contributes to disease progression. NICE guidance and NHS advice recognise that reducing sodium intake helps manage blood pressure, which may indirectly benefit liver health by reducing cardiovascular risk and metabolic strain.

It is important to note that there is no established causal link between salt and fatty liver disease. The relationship appears to be associative rather than direct, with indirect effects through metabolic syndrome, hypertension, and inflammation. Moderating salt intake forms part of a comprehensive approach to managing hepatic steatosis and overall cardiovascular and metabolic health, particularly when combined with other dietary and lifestyle factors.

Recommended Salt Intake for Fatty Liver Patients

The NHS recommends that adults consume no more than 6 grams (approximately one teaspoon) of salt per day, equivalent to 2.4 grams of sodium. This guidance applies to the general population, including those with fatty liver disease. (To convert sodium values on food labels to salt, multiply by 2.5.) Individuals with NAFLD who also have hypertension, diabetes, or cardiovascular disease may benefit from individualised sodium restriction as advised by their healthcare team; the World Health Organization suggests a conditional target of 5 grams daily for adults, though this is not a specific UK recommendation.

For people with fatty liver disease, achieving these targets requires careful attention to both obvious and hidden sources of salt. In the UK, approximately three-quarters of dietary sodium comes from processed and restaurant foods rather than salt added during cooking or at the table. Common high-sodium culprits include:

• Processed meats (bacon, sausages, ham)

• Ready meals and takeaways

• Bread and bakery products

• Breakfast cereals

• Cheese and dairy products

• Condiments and sauces (soy sauce, ketchup, stock cubes)

• Canned soups and vegetables

• Savoury snacks (crisps, salted nuts)

Reading food labels becomes essential for managing sodium intake. In the UK, nutrition labels display salt content per 100 g and per serving. Foods containing more than 1.5 g salt per 100 g are considered high in salt, whilst those with 0.3 g or less per 100 g are low. The traffic-light labelling system, overseen by the Food Standards Agency, helps consumers make quick decisions, with red indicating high salt content.

Patients with fatty liver disease should work with their GP or a registered dietitian to establish personalised sodium targets based on their overall health status, medications, and other dietary requirements. Those taking certain medications, such as diuretics or medications for hypertension, may require specific guidance on sodium and fluid balance. Regular monitoring ensures that dietary modifications support rather than complicate their treatment plan.

Dietary Changes to Support Liver Health

Beyond reducing salt intake, comprehensive dietary modifications can significantly improve fatty liver disease outcomes. NICE guidance (NG49) emphasises lifestyle intervention as the cornerstone of NAFLD management, with diet playing a central role. The primary goal is achieving gradual, sustainable weight loss of 7–10% of body weight, which has been shown to reduce liver fat, inflammation, and even fibrosis in many patients.

The Mediterranean-style dietary pattern has emerged as particularly beneficial for liver health. This approach emphasises:

• Abundant vegetables, fruits, and whole grains

• Healthy fats from olive oil, nuts, and oily fish (salmon, mackerel, sardines)

• Lean proteins including poultry, legumes, and pulses

• Limited red meat and processed foods

• Minimal added sugars and refined carbohydrates

This dietary pattern naturally tends to be lower in sodium whilst providing anti-inflammatory omega-3 fatty acids, antioxidants, and fibre that support liver function and metabolic health.

Specific nutrients and foods warrant particular attention. Reducing intake of fructose-containing foods and beverages (including fruit juices and sweetened drinks) helps decrease hepatic fat synthesis. Increasing dietary fibre from vegetables, whole grains, and legumes improves insulin sensitivity and promotes beneficial gut bacteria. Coffee consumption has been associated with reduced liver disease progression in observational studies; however, this should not be interpreted as a treatment recommendation, and coffee is not suitable for everyone (e.g., during pregnancy or for those sensitive to caffeine).

Practical strategies for implementing these changes include meal planning, cooking at home more frequently, using herbs and spices instead of salt for flavouring, and gradually transitioning away from ultra-processed foods. Portion control matters as much as food quality—even healthy foods consumed in excess can contribute to weight gain and liver fat accumulation. Keeping a food diary can help identify patterns and areas for improvement.

Whilst some emerging evidence explores meal timing and distribution, the primary focus should remain on total energy balance and diet quality. Extreme dietary restrictions or fad diets are not recommended, as they are difficult to sustain and may lack essential nutrients.

When to Seek Medical Advice About Fatty Liver

Fatty liver disease often develops silently without obvious symptoms, making regular medical monitoring essential for those at risk. You should consult your GP if you have risk factors including obesity (particularly a BMI over 30 or waist circumference over 94 cm for men of white European ethnicity, 80 cm for women; lower thresholds apply for people of South Asian, Chinese, Japanese, or other Asian ethnicity: ≥90 cm for men, ≥80 cm for women), type 2 diabetes, high cholesterol, hypertension, or metabolic syndrome. Many cases are discovered incidentally through blood tests or imaging performed for other reasons. It is important to note that liver blood tests (such as ALT, AST, and GGT) can be normal in people with NAFLD, so normal results do not rule out the condition.

Seek prompt medical attention if you experience:

• Persistent fatigue or weakness

• Discomfort or pain in the upper right abdomen

• Unexplained weight loss

• Jaundice (yellowing of skin or eyes)

• Swelling in the legs or abdomen

• Easy bruising or bleeding

• Confusion or difficulty concentrating

These symptoms may indicate disease progression to more advanced stages requiring urgent assessment.

NICE recommends that people with confirmed NAFLD undergo risk-based monitoring to assess disease progression. In UK primary care, this typically involves:

• Initial non-invasive fibrosis risk assessment using validated scores such as the FIB-4 index or NAFLD Fibrosis Score

• Second-line testing with the Enhanced Liver Fibrosis (ELF) blood test or transient elastography (FibroScan) if first-line scores suggest intermediate or high risk of advanced fibrosis

• Repeat fibrosis risk assessment at intervals (e.g., every 2–3 years if low risk; more frequently if intermediate or high risk) as determined by your healthcare team

• Cardiovascular risk assessment, as heart disease is the leading cause of death in NAFLD patients

• Ultrasound imaging may be used to detect steatosis or exclude other liver pathology, but does not measure liver stiffness

Your GP may refer you to a hepatologist (liver specialist) if there is evidence of significant fibrosis (e.g., high FIB-4 or ELF score, high liver stiffness on elastography), progressive disease, persistent abnormal liver blood tests beyond six months, or diagnostic uncertainty. Specialist referral is particularly important for patients with NASH, those who have not responded to lifestyle interventions, or when other liver conditions need to be excluded.

Regular follow-up allows healthcare professionals to adjust management strategies, provide ongoing support for dietary and lifestyle changes, and detect complications early. Remember that fatty liver disease is often reversible with appropriate intervention, particularly in its early stages, making timely medical engagement crucial for optimal outcomes.

Frequently Asked Questions