Fatty liver
Fatty liver means fat has built up in the liver. It usually has no symptoms and is found on an ultrasound or a blood test. This page explains why it matters, how it is assessed and what helps.
What is fatty liver?
Fatty liver means fat has built up in the liver. When the cause is not heavy alcohol use, it is called non-alcoholic fatty liver disease or, with the newer name, MASLD. If alcohol is the cause, it is called alcohol-related liver disease and is treated differently. That is why the doctor also asks about alcohol; answer honestly.
Based on the NHS source, the condition has four stages:
- Simple fatty liver. There is fat but no damage. Most people with it stay at this stage.
- MASH. The fat has caused inflammation, but the liver is not yet seriously damaged.
- Fibrosis. Scarring has formed in the liver, but the liver usually still works well.
- Cirrhosis. Severe damage that affects how the liver works.
From the second stage onwards, specialist follow-up is needed. The good news is that most people do not progress to the later stages, but nobody can say in advance which group you are in; that is why assessment is needed.
Symptoms
There are often no symptoms, and the condition is found during a test or ultrasound done for another reason. Some patients have tiredness, a general feeling of being unwell, or discomfort under the right ribs. These symptoms are not specific.
Who is more at risk?
The NIDDK source says excess weight and obesity, especially together with type 2 diabetes, raise the risk. High blood pressure and abnormal blood fats often go with it. The risk rises with age, but it can affect any age.
How is it assessed?
- History and examination. Questions about alcohol, medicines, weight, waist size and other conditions.
- Blood tests. Liver enzymes (ALT and AST) are common tests. The MedlinePlus source says abnormal results do not always mean a liver problem, and the doctor also weighs symptoms, history and medicines. From routine blood results, scores such as FIB-4 are sometimes calculated, which help to rule out or identify advanced scarring.
- Imaging. An ultrasound shows fat but not inflammation or fibrosis. Sometimes elastography (a measurement of liver stiffness) is requested.
- Liver biopsy. According to NIDDK, this is the only test that confirms MASH for certain, but it is not recommended for everyone.
What helps?
The main treatment is changing daily habits:
- Weight. According to the NIDDK source, losing at least 3 to 5 percent of body weight reduces liver fat, and up to 7 to 10 percent may be needed to reduce inflammation and fibrosis. Weight loss should be gradual; the same source says rapid weight loss and malnutrition make liver disease worse.
- Activity. The NHS source gives at least 150 minutes of exercise a week, and the NIDDK source says physical activity is useful even without weight loss.
- Food. A balanced diet in sensible portions. Do not start strict diets without the doctor’s opinion.
- Alcohol and smoking. The doctor advises how much alcohol, if any, is right for you. Stop smoking.
- Related conditions. Keep diabetes, blood pressure and blood fats under control according to the doctor’s plan. The NHS source says these changes also lower the risk of heart disease, chronic kidney disease, high blood pressure and type 2 diabetes.
- Medicines and supplements. The NIDDK source says some herbal remedies harm the liver. Tell the doctor about any supplement or herbal remedy before taking it.
Follow-up
The NHS source says people with the condition should have a check at least once a year and follow-up tests every two to three years. These intervals are general; if your liver is damaged, the doctor follows you sooner or more often.
When should you call?
Make an appointment if you have tiredness, loss of appetite, unexplained weight loss or pain under the right ribs, or if your liver tests have become abnormal.
Call 115 (the emergency number in Iran) at once if you vomit blood or your stools are black and tarry. The NHS source lists internal bleeding and liver failure among the complications of cirrhosis.
Every patient’s treatment plan is different; ask the doctor about your own situation.
Frequently asked questions
Is fatty liver dangerous?
The NHS source says most people with it stay at the first stage, which usually causes no problems. In a small number of people the fat leads to inflammation and then scarring in the liver. Which group you are in is something the doctor works out from blood tests and imaging.
My ultrasound says grade 1 fatty liver. Should I worry?
An ultrasound only shows that fat is present. The NIDDK source says routine ultrasound, CT and MRI do not show inflammation and scarring. The doctor uses blood tests and, if needed, other tests to judge whether the liver is damaged. Bring this report to your visit together with your test results.
Do I need medicine for fatty liver?
The NIDDK source (reviewed in 2021) says no medicine was approved for this condition, and the NHS source says medicine is usually not needed unless the liver is damaged and a specialist decides otherwise. Because research in this area is moving, ask the doctor which option, if any, suits you now. Do not take herbal remedies or supplements without telling the doctor.
If I lose weight, will my liver get better?
The NIDDK source says losing at least 3 to 5 percent of body weight reduces liver fat, and up to 7 to 10 percent may be needed to reduce inflammation and scarring. This is not a promise that applies to every person; the doctor can tell you what is reasonable to expect for you.
Can slim people get fatty liver?
It is more common with excess weight and type 2 diabetes, but a normal weight does not rule it out; the NIDDK source notes, for example, that among Asian Americans people with the condition have on average a lower body mass index. If your weight is normal and you have fatty liver, the doctor will also look for other causes.