2026 marked the fifth run of The State of Steatotic (Fatty) Liver Care in America survey. This initiative surveys the real-life experiences of adults with Steatotic Liver Disease (SLD) across the United States, promoting the ongoing development and implementation of practical solutions to improve diagnosis, treatment, care, and support for those affected by these conditions.
Key Findings
- Diagnosis: About half of diagnoses began at a routine primary care visit (27%) or by chance (25%). Nearly one in ten (9%) asked to be tested. Blood tests (67%) and ultrasound (51%) were most often used to confirm diagnosis, and 16% reported a biopsy.
- After diagnosis: Respondents were most often told to eat better or lose weight (49%) or were referred to a specialist (41%). More than one in three (35%) were not referred to a specialist, and about one in ten were told it was nothing to worry about.
- Information: Nearly three in four (74%) said they received no information or not enough information at diagnosis. Most looked online (86%).
- Care and treatment: Nutrition guidance, supplements, and medications were most often offered. Nearly one in four (23%) were not offered anything. Only 6% were offered mental health support, and 6% have a mental health professional on their care team.
- Daily life: Fatigue (65%) and sleep problems (44%) were the most common symptoms. Anxiety (61%) and depression (49%) were widely reported. About half (51%) rated their health as fair or poor.
- Support and costs: More than four in ten (42%) had no one to help them. Two in three (67%) rely on public insurance, and 43% have household incomes under $35,000.
2026 Report in Other Languages
Español (Spanish)
Tiếng Việt (Vietnamese)
中文 (Mandarin)
Beyond the Report
Five Years of Insights: 2022–2026 Comparison Report
With five years of patient-reported data from 2022 to 2026, this multi-year comparison report examines how diagnosis pathways, care team support, and patient experiences with Steatotic Liver Disease (SLD) have evolved across the United States over the past five years.
2022–2026 Key Findings
- Who responded: Over five years, most respondents were women, and average age rose from 57 in 2022 to 66 in 2026. Most are living with MASLD (57% in 2026) or MASH (28%).
- Diagnosis: Most diagnoses began with a primary care provider or by chance. Reported use of liver biopsy fell from 31% in 2023 to 16% in 2026, and the share diagnosed at Stage 4 fell from 21% to 12%, though more respondents (22% in 2026) did not know their stage.
- After diagnosis: Respondents were most often told to eat better or lose weight, or were referred to a specialist. The share with no specialist referral was 35% in 2026, and the share told their diagnosis was nothing to worry about fell from 24% to 11%.
- Information: Between 66% and 84% each year said they received no information or not enough information at diagnosis, and the internet was the most common source of information (86% in 2026).
- Care and treatment: Dietary and lifestyle advice was the most common care offered in earlier years. In 2026, 23% were offered nothing, and 6% were offered mental health support.
- Daily life: Fatigue and sleep problems were widely reported every year. Anxiety (61% in 2026) and depression (49%) were the most common mood changes. About half rated their health as fair or poor.
- Support and costs: The share with no one to help them was 42% in 2026. Reliance on public insurance grew from 47% to 67%, and 42% of respondents reported household incomes under $35,000 in 2026.