Fatty Liver Disease: Causes, Symptoms and Treatment

There are many reasons why someone might develop fatty liver disease, including obesity and high cholesterol. 

In this article, we will look at how to prevent fatty liver disease from developing in the first place. We will also look at the symptoms of fatty liver disease and what causes it. Finally, we will look at treatment options for fatty liver disease.

Fatty liver disease is not something that should be ignored. It can cause serious health problems and even death. Therefore, it is important to learn as much as possible about fatty liver disease before it becomes a problem.

Fatty Liver Disease

Fatty Liver Disease Symptoms

You may have non-alcoholic fatty liver disease (NAFLD) without any signs or symptoms. If there are symptoms, they are normally vague and non-specific. In the early stages, you may experience fatigue, malaise, or a dull ache in your upper right abdomen.

At a more advanced stage of fatty liver disease (NAFLD), you may experience:

  • Bleeding from engorged veins in your esophagus or stomach
  • Fatigue
  • Fluid in your abdominal cavity
  • Itching of your hands and feet, and eventually your entire body
  • Lack of appetite
  • Loss of interest in sex
  • Mental confusion, such as forgetfulness or trouble concentrating
  • Nausea
  • Small, red spider veins under your skin, or easy bruising
  • Swelling of your legs and feet from retained fluid
  • Weakness
  • Weight loss from muscle wasting
  • Yellowing of your skin and eyes and dark, cola-colored urine

Obesity puts individuals at risk of developing non-alcoholic fatty liver disease (NAFLD), which may progress to non-alcoholic steatohepatitis (NASH) and ultimately lead to cirrhosis, end-stage liver disease, and transplantation.

The exact cause of NAFLD, or fatty liver disease as it’s commonly called, is unclear. Many researchers, however, believe that metabolic syndrome — a cluster of disorders including hypertension, diabetes, high cholesterol and obesity — plays a crucial role in the development of fatty liver disease.

Though no established treatment is presently available for a fatty liver, weight loss has been shown to help reduce fat in the liver. 

Fatty Liver Disease Severity

A normal liver contains approximately 5% fat, and the rest of it is composed of liver cells that perform the liver’s vital work.

Healthy liver cells are replaced by fat cells when the liver’s fat content surpasseses 10%. This condition is referred to as fatty liver, or steatosis.

  • Simple fatty liver disease (steatosis): The progression of liver damage begins with deposits of fat in the liver that cause it to become enlarged. The condition usually doesn’t cause liver inflammation or scar tissue, and the risk of progressive liver damage is low. There are no symptoms. This is usually picked up on abdominal imaging with ultrasound or CT.
  • NASH (Non-alcoholic steatohepatitis): The accumulation of excess fat continues; inflammation and signs of necrosis begin to appear. Eventually, scar tissue forms as more liver cell injury occurs. NASH ranks as one of the major causes of cirrhosis and reason for liver transplant in the United States, after hepatitis C and alcoholic liver disease.
  • Cirrhosis: Liver scarring results in a hard, shrunken liver that is unable to function properly. Cirrhosis can be fatal.

Fatty Liver Disease Causes

How a liver becomes fatty is unclear. Some researchers speculate that the excess fat may get deposited from other parts of the body. Another theory is that the liver loses its ability to transform fat into a form that can be eliminated or used for energy by the body.

While the exact cause of NASH is also unknown, some believe that the disease progresses from one state to the next through a secondary trigger.

In people with some or all of the conditions associated with metabolic syndrome, the fat in the liver may be more likely to trigger an inflammatory response, causing scar tissue to develop and an elevation in liver enzymes.  

Conditions associated with metabolic syndrome are outlined below:

  • Obesity, especially around the waist (apple shape)
  • High blood pressure 
  • One or more abnormal cholesterol levels: high levels of triglycerides – a type of blood fat – or low levels of good cholesterol (high-density lipoprotein or HDL) 
  • Resistance to insulin or diabetes, a hormone that helps to regulate the amount of sugar in the blood

33% of American Adults at Risk

While NAFLD affects all age groups, it occurs most often in middle-aged and overweight or obese individuals, and in those who may also have elevated cholesterol and triglyceride levels and diabetes.

With the worsening obesity epidemic in children, NAFLD is becoming more and more prevalent in children and teens.  

Some scientists believe that fatty liver disease may be partly genetic. NASH was originally believed to be more common in women, and it is the most common cause of liver disease in adolescents.

With the increasing incidence of diabetes and obesity in Western countries, the relevance and high prevalence of NAFLD came to the forefront in the 1990s, and has become a serious concern among health care professionals.

Although exact figures are not yet available, some estimates suggest that fatty liver disease (NAFLD) may affect as many as one-third of American adults.

While a high percentage of people with simple fatty liver or NASH will not develop serious liver problems, without treatment these conditions can progress to cirrhosis, liver failure, and death.

Unless lifestyle changes are implemented, in fact, 10-20% of people with fatty liver will go on to develop cirrhosis, while 30-66% of those with NASH will develop cirrhosis. In some of these cases, the only survival option will be a liver transplant.

The risk of developing cirrhosis and liver failure is greatest in people over 45 who are affected by obesity, diabetes, or both.

Its association with obesity means that many people with fatty liver disease (NAFLD) will die of complications related to cardiovascular problems, rather than as a result of progressive liver disease itself.

In fact, some consider fatty liver disease a much more significant problem than chronic hepatitis C, which now has many treatment options.

Fatty Liver Disease

Diagnosing Fatty Liver Disease

Because NAFLD can be a silent disease – one that seldom shows signs and symptoms in its early stages – many people seek advice about treatment after a routine liver test to monitor cholesterol-lowering drugs, for example, returns abnormal readings.

At this point, you will more than likely be advised by your doctor that further testing is necessary to determine whether or not NAFLD is a factor.

Types of NAFLD Testing

Various tests provide details about the extent and type of liver damage you may be suffering from:

1. Liver function tests – These blood tests can reveal an increased presence of certain enzymes, released by the liver when it is damaged, including AST, ALT, bilirubin and alkaline phosphatase.

2. Ultrasound – A non-invasive test, this technology uses sound waves to create an image of your liver and does not require radiation.

3. Computerized tomography (CT scan) – CT X-rays produce cross-sectional images of your liver to get 3 dimensional views.  With contrast, several different types of liver lesions can be characterized (including benign lesions like hemangiomas as well as liver tumors).

4. Magnetic resonance imaging (MRI) – MRI technology produces an image of your liver via a magnetic field and radio waves.  Contrast dye is sometimes used for this test, but it does not involve radiation.  Special MRI techniques can allow a more detailed quantification of fat within the liver.

5. A liver biopsy A biopsy is the only way to conclusively diagnose NAFLD. Normally performed under local anesthesia, this procedure involves the removal of a small sample of tissue from the liver – usually with a thin cutting needle. The sample is then examined under a microscope.

This can be done percutaneously (through the skin) on the right side under the ribs, through a transjugular approach – through a blood vessel in the neck. Or by endoscopic ultrasound guidance where the liver is punctured by a needle passed through a scope that has been inserted into the stomach.

Fatty Liver Disease Treatment

Lifestyle changes, including diet, exercise and weight loss can help reduce fat in the liver.

Avoiding medications which can be toxic to the liver, like high doses of Tylenol and certain antibiotics, anti-seizure medications, and herbal/dietary supplements. Alcohol and recreational drugs should also be avoided.  

Milk thistle is believed to protect the liver from damage caused by alcohol, certain drugs, toxins, and viruses, but evidence is mixed.

While there is currently no standard for treating NAFLD, trials are presently being carried out in order to determine effective treatments.

General treatment recommendations include:

  • Reducing alcohol intake
  • Treatment of lipid disorders (problems that impair the way the body uses dietary fat)
  • Strict control of diabetes (since insulin may act as a trigger)
  • Treatment of high blood pressure
  • Avoidance of certain drugs and other substances known to cause liver damage (like Tylenol)
  • Weight loss

Eating fatty foods does not itself cause fatty liver. However, a healthy diet and weight loss can help reduce fat content within the liver and slow or reduce progression to NASH and cirrhosis. Bariatric surgery is indicated in some cases to help with weight loss.

Once a patient reaches the fatty liver stage, lifestyle habits may have already contributed to weight problems, and possibly obesity. This, in turn, can lead to diabetes and high blood cholesterol, which contribute to a fatty liver.  Regular alcohol consumption can also increase fat deposition in the liver.

In addition to milk thistle, nutritional supplements containing alpha-lipoic acid, N-acetyl cysteine, and Omega-3 fatty acids are also cited by some physicians as being helpful to damaged liver.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that experimental approaches currently under review for NASH patients include antioxidants, such as vitamin C, vitamin E, and selenium.

The antioxidants vitamins C and E are believed to be helpful in reducing liver damage caused by destructive, unstable oxygen molecules.

Complications from untreated non-alcoholic fatty liver disease (NAFLD) can be grim. If you suffer from any kind of metabolic disorder – particularly diabetes or high cholesterol – and you are overweight, it’s doubly important to do everything you can to protect one of your most valuable assets: your liver.

Other articles you might be interested to learn more about liver conditions:

Julie C. Guider MyGoodGut

Medically reviewed by Julie Guider, M.D.

Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.