Fatty liver disease, also known as hepatic steatosis, is a condition where excess fat builds up in the liver, which can lead to inflammation and liver damage. There are different types of fatty liver disease, including non-alcoholic fatty liver disease (NAFLD), which can have many causes, and alcoholic fatty liver disease (AFLD), which is caused by excessive alcohol consumption1. About 38 percent of Americans have NAFLD, and the incidence has increased sharply in recent years2. With proper management, fatty liver disease can be controlled and even reversed, but early detection is crucial for better outcomes. This article explores the symptoms, causes, risks, diagnosis, and treatment options for this common disease.
What Is Fatty Liver?
Fatty liver disease is associated with an accumulation of fat in liver cells. This leads to reduced liver function, harmful symptoms and may ultimately cause liver failure and liver cancer. Fat can build up in the liver for various reasons, and the specific cause of this accumulation helps differentiate the types of fatty liver disease1.
The Difference Between NAFLD and AFLD
AFLD, as the name suggests, is caused by excessive alcohol consumption. Alcohol is processed in the liver, and when we consume too much, the excess prevents the liver from breaking down fat molecules, leading to accumulation3. NAFLD, on the other hand, is caused by many factors and is linked to obesity, diabetes, and metabolic syndrome. In some cases, it results from consuming excessive fats, while other cases involve a more complex combination of factors1.
What Are the Consequences of Fatty Liver Disease
The early stages of fatty liver disease are known as simple fatty liver (steatosis). However, it can progress to non-alcoholic steatohepatitis (NASH), in which there is damage to liver cells, and to later stages of liver scarring called fibrosis and ultimately cirrhosis (severe scarring)1.
What Are the Symptoms of Fatty Liver?
Fatty liver disease is often asymptomatic in the early stages. It also shares symptoms with many different diseases, making it challenging to diagnose in some cases1. Symptoms typically become more pronounced at later stages and can include4:
- Fatigue and weakness - Feeling tired and low on energy, even without doing much.
- Pain or discomfort in the upper right abdomen - A dull ache or pressure on the right side of your belly, just under the ribs.
- Unexplained weight loss - Losing weight without trying or knowing why.
- Jaundice - Skin and eyes turning yellow because the liver isn’t working properly.
- Swelling in the legs and abdomen (if cirrhosis develops) - Puffiness or bloating in the belly and legs due to fluid buildup.
What Are the Causes of Fatty Liver?
There are many causes of fatty liver disease. However, some causes are far more prevalent than others. Below are some of the more common causes of this disease.
- Excess calorie consumption - Consuming too many calories is linked to fatty liver, and this disease is more commonly observed in obese individuals5. However, low-calorie diets may also increase the risk of this disease if they are high in fats6.
- Insulin resistance and metabolic syndrome - Insulin is crucial for regulating blood sugar and also helps control fat levels by inhibiting the enzymes that release fat into the bloodstream. Insulin resistance means that excess fat molecules are released into the blood and end up being stored in the liver1.
- Excessive alcohol intake - The liver is responsible for processing toxins, including alcohol. Excess alcohol damages liver cells and triggers fat accumulation.
- Certain medications - Drugs like corticosteroids and chemotherapy are linked to fatty liver disease7,8.
- Underlying medical conditions - Conditions such as high cholesterol, type 2 diabetes, and hypothyroidism are linked to fatty liver disease9.
What Are the Risk Factors for Fatty Liver?
Is Fatty Liver Genetic?
Genetics plays a role in fat metabolism and liver function10. Studies have also reported genetic links to fatty liver disease, and certain populations may have a higher genetic risk for developing this condition. For example, studies have found that close relatives of individuals with fatty liver have a higher risk of developing the disease. Furthermore, African Americans have lower rates of NAFLD compared to Americans of European descent, whereas Hispanic Americans have the highest prevalence of the disease11.
Fatty Liver and Obesity
Obese individuals are more likely to develop NAFLD. This can be attributed to increased calorie consumption, which leads to fat accumulation in the liver. However, the accumulation of visceral fat (fat around organs) is also thought to contribute to NAFLD by triggering inflammation and contributing to insulin resistance. This means that weight loss is a crucial tool for combatting fatty liver disease12.
Cirrhosis and Fatty Liver
Simple fatty liver is the earliest stage of liver disease. However, if left untreated, it can progress to more severe forms of liver dysfunction. Cirrhosis is permanent scarring of the liver and is associated with liver failure and liver cancer1. Patients with liver cirrhosis may require drastic interventions such as transplantation13.
How is Fatty Liver Diagnosed?
Doctors use several methods to help diagnose fatty liver. However, it is often found accidentally during imaging tests for other conditions1,14,15.
- Physical examination – The doctor may check for signs of liver disease like swelling, yellow skin, or an enlarged liver and ask about alcohol use, diet, and medical conditions.
- Blood tests – These are used to measure the function of liver enzymes and can indicate liver damage or fatty liver disease.
Imaging tests
- Ultrasound – A quick, painless scan that uses sound waves to detect fat buildup in the liver.
- Magnetic Resonance Imaging (MRI) or Computed Tomography scan – Advanced imaging to provide a clearer, more detailed image of the liver’s condition.
- FibroScan (elastography) – Measures liver stiffness to check for scarring or fibrosis.
- Liver biopsy – A small tissue sample is taken from the liver to confirm severe conditions like NASH or advanced fibrosis.
How Can I Reverse Fatty Liver?
Fortunately, there are ways to reverse fatty liver disease and prevent it from progressing to more severe stages.
- Weight loss - This is considered the most effective method for reversing fatty liver disease. Losing 5-10 percent of your body weight can significantly reduce liver fat and have positive effects at advanced and early stages of the disease16.
- Dietary changes - Dietary changes can contribute to weight loss, but they can also help us put less pressure on our livers and support our metabolism. Reducing sugar, refined carbohydrates, and processed foods while increasing fiber and healthy fats can help to combat fatty liver disease17.
- Regular exercise - Getting at least 150 minutes of moderate-intensity exercise per week can help reduce liver fat18. An emphasis on resistance training may be particularly helpful19.
- Managing underlying conditions - Tackling underlying health issues that contribute to fatty liver, such as diabetes, high cholesterol, and high blood pressure, can help reduce its impact20.
- Avoiding alcohol - Eliminating alcohol consumption is essential when managing AFLD and is also beneficial for NAFLD patients21.
- Medications and supplements - While lifestyle changes are the most critical factor in reversing and treating fatty liver disease, doctors may prescribe supplements like vitamin E and fish oil or drugs like metformin in some cases1. The FDA recently approved the first drug to treat NASH in 2024, and research for other solutions is ongoing22,23.
Is Fatty Liver Curable?
Fatty liver can be reversed if caught early. This is generally achieved through lifestyle changes such as improved diet and exercise. However, once fibrosis or cirrhosis of the liver develops, the damage is often irreversible24,25. This means that being proactive about your liver health is essential, particularly if you are diagnosed with an early stage of fatty liver.
Summary: Fatty Liver - Symptoms, Risk Factors, Causes, Diagnosis, and How to Reverse It
Fatty liver disease is a growing health concern, often linked to obesity, metabolic syndrome, and excessive alcohol consumption. While early stages may be asymptomatic, progression can lead to severe complications like cirrhosis and liver failure. Fortunately, lifestyle changes such as weight loss, a healthy diet, exercise, and managing underlying conditions can help reverse fatty liver. Early detection and proactive management are crucial to preventing long-term liver damage and improving overall health.
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