Fatty liver disease

Your liver has a role in digesting foods and ridding your body of toxic substances. It's healthy to have a small amount of fat in your liver, but if the fat builds up it can cause inflammation. Having too much inflammation in your liver can keep it from doing its jobs. While your liver can repair itself when it's mildly damaged, severe damage can progress to permanent scarring or cirrhosis of the liver. This can lead to liver failure or even liver cancer. If you have fatty liver disease you are also at increased risk of heart problems, kidney disease and strokes. Read more about liver disease.

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Fatty liver disease isn't caused just by eating fatty foods. It's usually due to a combination of things happening in your body over a long period of time. 

Alcohol-related fatty liver disease

Excess alcohol is the main cause of alcohol-related fatty liver disease. Fatty liver develops in 46 to 90% of people who drink a lot of alcohol. For some people, 5 to10 standard drinks per week may be enough to cause fatty liver disease. Read more about alcohol and how much a standard drink is.

Metabolic associated steatotic liver disease (MASLD) 

MASLD used to be called non-alcoholic fatty liver disease or NAFLD. Some people get fatty liver disease without having any pre-existing conditions. However these risk factors make you more likely to develop it: 

• Being overweight or obese.
• Having type 2 diabetes or insulin resistance.
• Metabolic syndrome. 
• Underactive thyroid. 
• Polycystic ovarian syndrome.
• Protein malnutrition (low protein in the diet).
• Starvation or rapid weight loss (losing too much weight too quickly). 
• Some medicines. 

Use this screening test(external link) to see if you are at risk of liver disease. 

Video: The stages of NAFLD (non-alcohol related fatty liver disease) – now known as MASLD

Watch a video about the stages of NAFLD. This video may take a few moments to load.

(British Liver Trust, UK, 2022)

In the early stages of fatty liver disease you may have no symptoms. Some people get symptoms such as: 

• feeling weak and tired all the time
• weight loss 
• a pain or discomfort in the upper right part of your stomach
• nausea
• swelling in your tummy region
• poor appetite. 

If you have ongoing symptoms and concerns talk to your doctor about them. 

If fatty liver disease progresses to cirrhosis, more severe symptoms can develop. These include yellowing of the skin and whites of the eyes (jaundice), body swelling and an enlarged spleen. 

Diagnosis

It can be hard to diagnose fatty liver disease, especially when the disease is still in its early stages. Your healthcare provider may suspect it after examining your symptoms and medical history. 

Diagnosis is usually confirmed through:

• Blood tests, eg, liver function, cholesterol and Haemoglobin A1c (HbA1c, a measure of blood glucose control) or fasting blood glucose.
• A special ultrasound of your liver, sometimes called a fibroscan. This can tell your doctors how much scarring there may be in your liver.

Management

There's no specific treatment for fatty liver disease, although other associated conditions (eg, diabetes, high blood pressure and high cholesterol) may be treated with medicine.

Lifestyle changes are the best way of managing fatty liver disease in order to reduce the progression and even reverse liver damage. These include:

• cutting down or stopping drinking alcohol
• regular exercise 
• treating other liver conditions such as hepatitis B or C
• stopping smoking
• getting your blood pressure levels under control
• managing your cholesterol level
• having a healthy weight
• eating a balanced and healthy diet and reducing fat and sugar intake
• avoiding starvation, excess dieting and protein malnutrition
• blood glucose control.

Let your healthcare provider know if you're taking any medications (including herbal medications and supplements) or other drugs. These may be harmful to your liver. Your healthcare provider can advise about reducing or stopping them if needed.