Fatty Liver Disease: Causes, Symptoms and Treatment

Fatty liver disease is a condition where excess fat accumulates in the liver cells, leading to inflammation and damage. It is becoming increasingly common, affecting up to one-third of adults in developed countries.

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

One of the most concerning aspects of fatty liver disease is that it often develops without any symptoms until significant damage has occurred. This means that many people may be living with this condition without even realizing it. Early detection and intervention are key to preventing further progression and improving outcomes for those affected.

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

Definition And Overview Of Fatty Liver Disease

It is estimated that up to 25% to 33% of adults in Western countries suffer from fatty liver disease. This statistic alone should be enough to raise awareness about the importance of understanding what causes and prevents it.

Fatty liver disease occurs when there is an accumulation of fat in your liver cells. This excess buildup can lead to inflammation and scarring, causing damage to this vital organ. There are two main types: alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD).

As their names suggest, AFLD is caused by excessive alcohol consumption while NAFLD arises due to factors such as obesity, high cholesterol levels, or diabetes. Prevention is critical given that fatty liver disease usually has no symptoms until significant damage has occurred.

Adopting healthy lifestyle habits like maintaining a balanced diet and engaging in regular exercise can help reduce your risk of developing this potentially life-threatening illness. Understanding more about both types will give you greater control over protecting yourself against them- which we’ll explore next.

Fatty Liver Disease Symptoms

Symptoms of fatty liver disease often go unnoticed until significant damage has been done. However, there are warning signs associated with fatty liver disease that can help detect its presence early on before it becomes severe enough to cause irreversible damage to your health.

These include fatigue, abdominal pain, and yellowing of the skin or eyes. If you experience any of these symptoms, it’s crucial to seek medical attention immediately.

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. 

Making simple changes to your diet can help prevent and even reverse fatty liver disease. Start by cutting back on sugar and saturated fats while increasing your intake of fruits, vegetables, and whole grains. Regular exercise is also crucial in maintaining a healthy weight and reducing your risk of developing this condition.

Remember: prevention is always better than cure.

Don’t wait until it’s too late – get screened regularly.

Take control of your health through proper nutrition and exercise.

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. Learn to look out for liver cirrhosis symptoms.

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

Obesity is a significant contributor to the development of fatty liver disease. The link between obesity and fatty liver disease arises due to increased insulin resistance leading to fat accumulation in the liver.

This process happens when there is too much glucose circulating in your bloodstream, which causes your body to produce more insulin than it needs. As a result, this extra insulin circulates in your blood and signals your liver cells to store excess glucose as fat.

Focusing on healthy lifestyle choices such as maintaining a balanced diet and limiting alcohol consumption can help reduce this risk considerably.

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

Diagnosing fatty liver disease is crucial to ensure accurate treatment and prevent further complications. A physical exam, blood tests, and imaging techniques are the primary methods used for diagnosis accuracy.

These tests help determine the severity of the condition and guide doctors on how to approach treatment. Blood tests can detect elevated levels of certain enzymes that indicate liver damage. However, it’s important to note that not all patients with fatty liver disease will have abnormal blood test results.

Therefore, imaging techniques such as ultrasound, CT scans, or MRI may be necessary to confirm a diagnosis accurately. Ultrasound is often the first imaging technique used for diagnosing fatty liver disease because it’s non-invasive and cost-effective.

It uses sound waves to create images of organs in the body, including the liver. CT scans and MRIs provide more detailed images but are more expensive than ultrasound. Accurate diagnosis through these tests allows us to formulate an effective treatment plan tailored specifically to each patient’s needs, increasing their chances of recovery without complications.

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 of liver 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. Read more about Milk Thistle Tea for Liver.

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.

Lifestyle Changes For Preventing Fatty Liver Disease

It is crucial to manage fatty liver disease through lifestyle changes to prevent these outcomes. Studies have shown that dietary modifications and physical activity recommendations are effective in reducing fat accumulation in the liver.

Dietary modifications should focus on reducing sugar and saturated fats while increasing fiber intake. This means cutting back on processed foods, sugary drinks, and red meat while incorporating more fruits, vegetables, whole grains, and lean protein sources like fish or chicken. Portion control is also essential for weight management since excess body weight contributes to fatty liver disease.

Physical activity recommendations include at least 30 minutes of moderate-intensity exercise most days of the week. This could include brisk walking, cycling, swimming or any other form of aerobic activity that gets your heart rate up. Resistance training with weights or resistance bands may also help improve insulin sensitivity and reduce fat accumulation in the liver.

Moving forward with a diagnosis of fatty liver disease requires making significant lifestyle changes that can feel overwhelming. However, by focusing on dietary modifications and physical activity recommendations, you can take control over your health and potentially reverse the progression of this condition.

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

Fatty Liver Disease FAQs

Can Fatty Liver Disease Be Cured?

The liver is a resilient organ and there is the possibility for fatty liver disease to be reversed and even cured completely.

While there is no guaranteed cure for fatty liver disease, making lifestyle adjustments such as reducing alcohol consumption, cutting back on processed foods high in sugar and saturated fats, and increasing physical activity can help manage symptoms and prevent further progression.

With the right approach to diet and exercise, individuals with fatty liver disease can take control of their health and potentially achieve complete recovery.

Can Alcohol Consumption Cause Fatty Liver Disease Even In Moderate Amounts?

Alcohol consumption in moderation is generally accepted as safe for most individuals.
However, it’s important to note that even moderate amounts of alcohol can still cause fatty liver disease over time. Fatty liver occurs when there is an excess buildup of fat in the liver cells.

This condition not only affects your liver health but also your overall well-being. So, if you want to maintain good health and avoid potential complications such as cirrhosis or liver cancer, it’s best to limit your alcohol intake and ensure that you’re leading a healthy lifestyle.

Remember, moderation is key when it comes to maintaining optimal health!

Is Fatty Liver Disease Hereditary?

Genetic predisposition can play a role in the development of fatty liver disease. However, it’s important to note that lifestyle factors such as diet and exercise can also contribute to its onset.

While you may not have control over your genetics, making healthy choices regarding your lifestyle is one way you can potentially prevent or manage this condition.

It’s always recommended to speak with your healthcare provider about any concerns you may have regarding potential hereditary factors and how they could impact your health.

How Long Does It Take For Fatty Liver Disease To Develop?

Fatty liver disease’s development timeline varies from person to person. However, we know that several risk factors contribute to its onset, including obesity, insulin resistance, and genetics.

While there is no definitive answer on how long it takes for the condition to develop fully, studies suggest that patients with non-alcoholic fatty liver disease (NAFLD) could take years before showing any symptoms or complications.

Is Fatty Liver Disease Reversible?

Fatty liver disease is reversible, but it depends on several factors. Reversibility factors include the severity of the condition and the lifestyle changes made by the patient.

Lifestyle changes such as exercise, healthy eating habits, and weight loss can help reduce inflammation in the liver and improve its overall function. With dedication and effort towards improving one’s lifestyle habits, reversing fatty liver disease is very possible.

Written and Medically Reviewed By

  • Sheila Jennings

    Sheila Jennings is a 4th-year medical student and also freelances as a content writer on gut health, nutrition, and food. She lives with IBS and has learned how to keep her symptoms at bay through a healthy diet and exercise. She wants to educate others on what they can do to take back control of their gut health and live like they used to.

  • 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.