Overview
Fatty liver disease is a build-up of fat inside the liver in people who drink little or no alcohol. It is closely tied to extra weight and to type 2 diabetes, and is now also called MASLD.
It is described in four stages: fat gathering in the liver, where most people stay; inflammation and damage, called steatohepatitis; scarring, called fibrosis; and cirrhosis, where the scarring is widespread and the liver begins to fail.
Symptoms
The early stages are silent. Most people feel well and learn about it only when a test is done for another reason.
- Tiredness that does not lift
- A dull ache under the right ribs, and feeling generally unwell
- Later, with cirrhosis: yellow skin and eyes, itching, swollen ankles or tummy, and easy bruising
When to see a doctor
See a doctor in the next few days if a scan or blood test has reported a fatty liver, if tiredness or a dull ache under the right ribs will not settle, or if you have diabetes or high and the liver has never been checked.
Causes
Fat collects in the liver when the body takes in more energy than it uses and stops responding properly to , the hormone that controls blood sugar. That is why fatty liver so often accompanies extra weight, diabetes and raised .
Not everyone with fatty liver is overweight, and not everyone overweight develops it, so other things, including inherited genes, play a part.
Risk factors
- Being overweight, particularly around the middle
- Type 2 diabetes or
- High , high or high triglycerides
- Polycystic ovary syndrome
- A diet high in sugar, refined flour and fried food, with little activity
- Age over 50
Complications
The concern is the smaller number whose liver moves from fat to inflammation, then scarring, then cirrhosis. A liver with cirrhosis cannot work properly, which can lead to fluid in the tummy, bleeding from swollen veins in the food pipe, jaundice, confusion, serious infections and liver cancer.
Prevention
- Keeping to a healthy weight, losing it steadily rather than very fast
- Eating more vegetables, fruit, dal and whole grains, and less sugar and fried food
- Being active for at least 150 minutes a week, such as a brisk walk most days
- Keeping blood sugar, and in range
- Staying within safe alcohol limits, and not using tobacco
Diagnosis
Fatty liver is often picked up when blood tests or an are done for another reason. A doctor will ask carefully about alcohol, check weight and waist, look for diabetes and problems, and rule out causes such as viral hepatitis.
Because blood tests can be normal even when there is scarring, further tests may estimate how much fibrosis there is: scores from blood results, and a scan that measures liver stiffness. A is used when the picture is unclear.
Treatment
The main treatment is losing extra weight, because that reduces fat, inflammation and even early scarring. Steady weight loss through a better diet and regular activity works better than crash dieting, and helps blood sugar and too.
No medicine has been approved specifically for fatty liver disease. Doctors treat the conditions that go with it: diabetes, and cholesterol. A specialist may consider particular medicines where there is significant inflammation or scarring, and weight-loss surgery suits some people with severe obesity.
Regular follow-up matters, because repeat tests show whether the liver is stable or changing. Cirrhosis is managed by a liver team, and a transplant is considered when the liver fails.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Fatty liver only happens to people who drink alcohol, so the report must be wrong.”What is true?
Fact
This is a different condition. Non-alcoholic fatty liver disease, now also called MASLD, builds up in people who drink little or no alcohol. It is linked to extra weight, type 2 diabetes, high blood pressure and high cholesterol.
Myth“Fatty liver is just something written on a scan report. Nothing needs to be done.”What is true?
Fact
Most people do stay at the early stage, where only fat has gathered. In some the fat causes inflammation, then scarring, and over years cirrhosis, which affects how the liver works. The early stage is the point at which changes still make the most difference.
Myth“There must be a tablet or a liver tonic that will clear the fat.”What is true?
Fact
No medicine has been approved to treat fatty liver disease. What has been shown to reduce fat, inflammation and scarring in the liver is losing weight, with a better diet and regular activity. A liver specialist may use particular medicines in advanced cases.
Myth“Once the liver has fat in it, the damage is done for good.”What is true?
Fact
The liver can recover a great deal. Losing extra weight steadily reduces the fat, and can also reduce inflammation and early scarring. Cirrhosis, the late stage, cannot be reversed, which is why the earlier stages are worth acting on.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
I do not drink alcohol at all. How can my liver be fatty?
This kind of fatty liver has nothing to do with alcohol. It is driven by the way the body handles energy and insulin, so it appears alongside extra weight, type 2 diabetes, high blood pressure and high cholesterol. It is common in people who have never touched alcohol.
How much weight do I need to lose?
Even a modest, steady loss helps the liver, and the more weight is lost the greater the benefit tends to be. Your doctor will set a target that suits your build and your other conditions, and will usually aim for gradual loss rather than a rapid drop.
Are liver tonics and herbal supplements useful?
No medicine has been approved to treat fatty liver disease, and herbal products are not a substitute for weight loss and activity. Some supplements can themselves harm the liver, so it is worth telling your doctor about anything you are taking, including remedies bought without a prescription.
Will this shorten my life?
For most people it stays at the early stage and does not cause serious liver trouble. The risk lies with the smaller group who develop inflammation and scarring, which is why follow-up is advised. Treating the weight, sugar, blood pressure and cholesterol that come with it benefits the heart as well as the liver.
