15831 Fatty Liver Disease

Overview

Fatty liver disease is a condition where fat builds up in the liver cells. It is common and often causes no harm at first, but in some people it can lead to liver inflammation, scarring, and eventually liver damage.

Yes. It is the most common liver disorder in the UK and around the world. About 1 in 3 adults has some fatty change in the liver.

It can affect people of any age, but is more common in middle age. It is especially seen in people who are overweight, have type 2 diabetes, high blood pressure, or high cholesterol. Children can also develop it, particularly if they are obese.

Symptoms

Common symptoms

• Usually no symptoms in the early stages.
• Sometimes a dull or aching pain in the upper right side of the belly (abdomen).
• Feeling tired or generally unwell.
• Unexplained weight loss.

Symptoms in children

• Often no symptoms either.
• Sometimes stomach pain, tiredness, or difficulty concentrating.

Symptoms in older adults

• Older adults may have more fatigue, weakness, or confusion if liver function worsens.
• They may also have more coexisting conditions like diabetes and heart disease.

Causes

Main causes

• The exact cause is not fully understood, but fat builds up in the liver when the body's energy balance is out of sync.
• It is strongly linked to being overweight or obese, especially around the waist.
• Insulin resistance (when the body does not use insulin properly) is a key driver.
• High levels of fat (triglycerides) in the blood can contribute.
• Alcohol is a separate cause of fatty liver; if you drink heavily, alcohol-related fatty liver disease can develop.

Risk factors

• Type 2 diabetes or prediabetes
• High blood pressure
• High cholesterol or triglycerides
• Being overweight or obese
• Rapid weight loss or malnutrition (in some cases)
• Certain medications (but this is less common)
• Polycystic ovary syndrome (PCOS)

When to see a doctor

See a doctor urgently if:

• If you develop jaundice, vomiting blood, black stools, or confusion, seek emergency care now.

Book a routine appointment if:

• If you have persistent tiredness, belly pain, or unexplained weight loss, make an appointment.

Diagnosis

Fatty liver disease is often found by chance during a blood test or scan for another reason. A doctor will usually ask about your history, examine you, and arrange tests to check your liver.

Tests that may be done

• Blood tests, including liver function tests (LFTs) and tests for viral hepatitis.
• Imaging scans, such as an ultrasound, CT scan, or MRI, to look at the liver.
• A special measurement called liver elastography (FibroScan) to check for scarring (fibrosis).
• In rare cases, a liver biopsy may be needed to confirm the diagnosis and assess damage.

What to expect at your appointment

Your doctor will explain what the tests show and what they mean. If you have fatty liver disease, they will usually focus on lifestyle changes and managing any other health conditions you have, such as diabetes, high blood pressure, or high cholesterol. They may want to re-check your blood tests and scans over time.

Treatment

There is no specific medicine approved just for fatty liver disease. The most effective treatment is lifestyle change. The main goal is to lose excess weight (even 5–10% can help), eat a balanced diet, and become more active. If you have diabetes or high cholesterol, the doctor will help you manage those as well.

Self-care at home

• Lose weight gradually and safely — losing about 5–10% of your body weight can significantly reduce liver fat.
• Eat a balanced, varied diet with plenty of vegetables, fruits, whole grains, and lean protein.
• Limit sugary drinks, fast food, and highly processed snacks.
• Move more — aim for at least 150 minutes of moderate activity per week, or as advised by your doctor.
• Avoid or limit alcohol — even small amounts can be harmful when your liver is fatty.
• Talk to your doctor before taking any supplements, herbs, or over-the-counter medicines, as some can be hard on the liver.

Medical treatments

Your doctor will treat any underlying conditions that contribute to fatty liver disease, such as type 2 diabetes, high blood pressure, and high cholesterol. For example, they may prescribe medicines to control blood sugar, blood pressure, or cholesterol. These medicines are not specific for fatty liver disease but help protect the liver from further harm. There are also newer medicines being studied, but none is a licensed ‘fatty liver pill’ at this time.

When is surgery considered?

Weight-loss (bariatric) surgery may be considered for some people with severe obesity and related health problems, including fatty liver disease. This is always a decision you make with a specialist.

Living with this condition

Living with fatty liver disease means focusing on long-term habits. You will likely need regular check-ups to monitor your liver and any other health conditions. Most people can manage it with lifestyle changes, and the liver can often repair itself if the fat is reduced.

Lifestyle tips

• Build a consistent routine around eating and exercise.
• Aim for a healthy weight — set small, realistic goals.
• Read food labels to spot added sugars and saturated fats.
• Find physical activities you enjoy, such as walking, swimming, or cycling.
• Get good sleep and find ways to manage stress.

Diet and exercise

A Mediterranean-style eating pattern is often recommended — rich in vegetables, fruits, whole grains, beans, nuts, seeds, and healthy fats like olive oil, with limited red meat and sweets. Regular exercise, even brisk walking, helps reduce liver fat. Always consult your doctor before starting a new exercise plan.

Mental health and emotional wellbeing

Receiving a liver diagnosis can feel worrying, and living with a chronic condition can affect your mood and stress levels. It is normal to feel anxious or low. Talk to your doctor if you are struggling — counseling, support groups, and sometimes medication can help. If you ever feel you might harm yourself, call your local emergency number right away.

Prevention

For most people, fatty liver disease can be prevented or improved by maintaining a healthy weight, eating well, staying active, and limiting alcohol. It is not caused by alcohol in the common type, but alcohol can make it worse.

Screening programmes

There is no standard screening test for the general population, but your doctor may check liver function during routine blood tests if you have risk factors like diabetes, obesity, or high cholesterol. In the UK, the NHS recommends testing for liver disease in some high-risk groups.

Complications

If left untreated

• In some people, fat in the liver can cause inflammation (non-alcoholic steatohepatitis, or NASH).
• This inflammation can lead to scarring of the liver (fibrosis).
• Over many years, scarring can progress to cirrhosis, which is serious and can lead to liver failure or liver cancer.

Long-term outlook

The outlook is often positive if fatty liver is caught early. Losing weight and improving your lifestyle can reduce liver fat, reduce inflammation, and even reverse early fibrosis. Only a small number of people progress to advanced liver disease. With regular medical care and heart-healthy habits, many people live full, healthy lives.

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