Fatty liver living in older adults

Overview

Fatty liver is a condition where too much fat builds up in your liver cells. It is common and often causes no problems at first. If it gets worse, it can lead to inflammation and scarring, which can harm your liver. The most common type is non-alcoholic fatty liver disease (NAFLD), which is not caused by drinking alcohol.

Yes, fatty liver is very common. About 1 in 3 adults in the UK may have some fat in their liver, and the risk increases with age. It is one of the most common liver conditions in older adults.

Fatty liver affects people of all ages, but it is more common in older adults, especially those over 60. It is more likely in people who are overweight, have type 2 diabetes, high blood pressure, or high cholesterol. It can also run in families.

Symptoms

Common symptoms

• Most people have no symptoms at all.
• Some people may feel tired or have a dull ache in the upper right side of the belly.

Symptoms in children

• Fatty liver can also affect children, especially those who are overweight. Most have no symptoms.

Symptoms in older adults

• Fatty liver often causes no symptoms in older adults.
• If symptoms do happen, they may include fatigue, weakness, or discomfort in the upper right abdomen.
• Later stages can cause confusion, swelling in the legs or belly, or easy bruising.

Causes

Main causes

• Being overweight or obese, especially around the belly
• Having type 2 diabetes or prediabetes
• High levels of fats in the blood, such as triglycerides and cholesterol
• Eating a diet high in sugar, refined carbohydrates, and unhealthy fats
• Being physically inactive

Risk factors

• Age – being over 60 increases risk
• Having metabolic syndrome (a group of conditions including high blood pressure, high blood sugar, and abnormal cholesterol)
• Rapid weight loss, which can cause fat to be released into the liver
• Certain medications (talk to your doctor about any concerns)
• Genetics – a family history of fatty liver or type 2 diabetes

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you have yellowing of the skin or eyes, or dark urine, see a doctor the same day.

Book a routine appointment if:

• If you have risk factors like obesity, diabetes, or high cholesterol, ask your doctor if you should be tested.
• If you feel tired or have mild belly discomfort for no clear reason, make a routine appointment.
• If you have been told you have fatty liver, follow up as advised by your doctor.

Diagnosis

Fatty liver is often found during routine blood tests or scans for other reasons. Your doctor will ask about your health, lifestyle, and any symptoms. They may feel your belly to check if your liver is enlarged.

Tests that may be done

• Blood tests – a liver function test can show if your liver is inflamed or damaged.
• Ultrasound scan – this uses sound waves to create a picture of your liver and detect fat.
• FibroScan – a special ultrasound that measures how stiff your liver is (stiffness can mean scarring).
• Liver biopsy – a small sample of liver tissue is taken to check for inflammation or scarring. This is only done if needed.

What to expect at your appointment

Diagnosis usually starts with a simple blood test and an ultrasound. These are painless and quick. If results show fatty liver, your doctor will discuss next steps. You may be referred to a liver specialist (hepatologist) for further tests.

Treatment

There is no specific medicine to treat fatty liver. The main treatment is making healthy lifestyle changes. If you have related conditions like diabetes or high cholesterol, managing those is also very important. Treatment focuses on slowing the disease and preventing complications.

Self-care at home

• Lose weight slowly and safely – losing 5-10% of your body weight can reduce liver fat and inflammation.
• Eat a balanced diet with plenty of vegetables, fruits, whole grains, and lean protein.
• Avoid sugary drinks, sweets, and refined carbs like white bread and pasta.
• Limit or avoid alcohol – even small amounts can be harmful for fatty liver.
• Stay physically active – gentle activities like walking, swimming, or chair exercises can help.

Medical treatments

Doctors may prescribe treatments for related conditions like diabetes, high blood pressure, or high cholesterol. They may also recommend vitamin E in some cases, but only under medical supervision. There are no approved medicines specifically for fatty liver. All treatments should be discussed with your healthcare provider.

When is surgery considered?

Surgery is rarely needed for fatty liver. In severe cases where the liver is badly scarred (cirrhosis) and failing, a liver transplant may be considered. This is a major operation and only for advanced disease.

Living with this condition

Living with fatty liver means making small, lasting changes to your daily habits. Many people feel better after improving their diet and activity level. You can still enjoy life – just be mindful of what you eat and drink. Regular check-ups with your doctor will help track your progress.

Lifestyle tips

• Eat a well-balanced diet – aim for plenty of vegetables, fruits, whole grains, and lean proteins.
• Stay active – even 30 minutes of walking most days can make a big difference.
• Keep a healthy weight – if you need to lose weight, do it slowly (0.5-1 kg per week).
• Avoid alcohol or keep it to a minimum – ask your doctor what is safe for you.
• Take all medicines as prescribed for other conditions like diabetes or high cholesterol.

Diet and exercise

A healthy diet and regular exercise are the best ways to manage fatty liver. Focus on a Mediterranean-style diet with lots of greens, nuts, fish, and olive oil. Cut down on red meat, fried foods, and sugary snacks. For exercise, find activities you enjoy and can do safely – walking, swimming, gardening, or gentle yoga. Always check with your doctor before starting a new exercise programme.

Mental health and emotional wellbeing

Being diagnosed with a liver condition can cause anxiety or worry. You might feel overwhelmed or unsure about what to do. It is normal to have these feelings. Talking to a trusted friend, family member, or a counsellor can help. If you are feeling very low or anxious, speak to your doctor – they can point you to support services. Remember, fatty liver is often reversible, and you are not alone.

Prevention

Fatty liver can often be prevented by maintaining a healthy weight, eating a balanced diet, staying active, and limiting alcohol. If you have diabetes or high cholesterol, managing those conditions well also helps reduce your risk. Even small changes can make a big difference.

Vaccines

There are no vaccines that prevent fatty liver, but staying up to date with vaccines for hepatitis A and B can protect your liver from other infections. Ask your doctor if these are right for you.

Screening programmes

There is no routine screening for fatty liver in the general population. However, if you have risk factors, your doctor may recommend a blood test or ultrasound. Talk to your doctor about your personal risk.

Complications

If left untreated

• Inflammation of the liver (non-alcoholic steatohepatitis or NASH)
• Scarring of the liver (fibrosis) that can progress to cirrhosis
• Cirrhosis – severe scarring that can lead to liver failure
• Increased risk of liver cancer (hepatocellular carcinoma)
• Higher risk of heart disease and stroke

Long-term outlook

The outlook for fatty liver is very good for most people. With early lifestyle changes, the condition can be reversed and scarring prevented. Even if you already have some scarring, stopping it from getting worse can keep your liver healthy for years. Your doctor will help you stay on track. Remember, many people live long, healthy lives with fatty liver.

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