Fatty Liver Disease

Fatty Liver Disease  

Fatty liver disease happens when fat builds up in your liver. This can cause damage, inflammation, and other complications.  

There are two main types of fatty liver disease: 

• Nonalcoholic fatty liver disease (NAFLD). As this name suggests, this type of fatty liver disease isn’t caused by drinking alcohol. 

• Alcoholic fatty liver disease. This is also known as alcoholic steatohepatitis. It’s caused by heavy alcohol consumption.

It’s possible to have both types of fatty liver disease at the same time. 

About one in four people worldwide have nonalcoholic fatty liver disease. It’s the most common cause of liver disease in the United States. 

NAFLD is broken down further into two types: 

• Nonalcoholic fatty liver (NAFL). Also known as hepatic steatosis or simple fatty liver disease, this occurs when there is too much fat in the liver but minimal inflammation or damage to the liver cells. 

• Nonalcoholic steatohepatitis (NASH). With this type of fatty liver disease, you’ll have fat in your liver, inflammation, and liver cell damage. This can lead to cirrhosis (liver scarring) and liver cancer. 

Most people with NAFLD have nonalcoholic steatohepatitis. Healthcare professionals aren’t sure why some people develop nonalcoholic fatty liver while others develop NASH.

If you have fatty liver disease, you’re more likely to develop health conditions like: 

• Cirrhosis

• Liver cancer 

• High blood pressure 

• Type 2 diabetes

• Cardiovascular disease 

• Metabolic syndrome

• Dyslipidemia (abnormal levels of lipids, or fats, in your blood)

Symptoms of Fatty Liver Disease  

Fatty liver disease is known as a “silent disease” as it has few symptoms. 

In fact, you might have fatty liver disease and not even know it. You may not experience any symptoms at all until it causes health problems. 

When symptoms are present, they can include fatigue and discomfort in the upper right side of your abdomen 

In very severe cases, as the condition progresses, you might experience: 

• Jaundice (when your skin or the whites of your eyes turn yellow due to liver damage) 

• Swelling in your abdomen or legs 

If fatty liver disease leads to cirrhosis, you might experience: 

• Fatigue 

• Weakness

• Nausea 

• Loss of appetite

• Weight loss

• Swelling 

• Jaundice

Causes of Fatty Liver Disease  

It’s unclear exactly what causes fatty liver disease when it isn’t caused by alcohol. 

Potential causes may include: 

• A high-fat diet 

• Overweight and obesity 

• Genetics

• Insulin resistance 

• Type 2 diabetes

• Dyslipidemia  

• Toxins 

• Medications like corticosteroids or some cancer drugs

Alcoholic fatty liver disease is caused by drinking too much alcohol over an extended period of time.

Risk Factors for Fatty Liver Disease  

Having overweight or obesity is a major risk factor for fatty liver disease. Estimates suggest that up to 75 percent of people with overweight have NAFLD, and more than 90 percent of people with severe obesity have the condition. 

The risk factors for alcoholic fatty liver disease include drinking heavily, especially if you’ve been drinking heavily for a long time. 

Among those who drink a lot, you’ll have a higher risk of fatty liver disease if you: 

• Have obesity 

• Are female 

• Have certain genes

Other risk factors for nonalcoholic fatty liver disease include: 

• Prediabetes 

• Type 2 diabetes

• Obesity 

• High blood pressure 

• Having high cholesterol or triglycerides 

• Metabolic syndrome 

• Rapid weight loss 

• Infections like hepatitis C 

• Some medications 

• Toxin exposure 

• Age 

• Ethnicity (you’re more likely to develop NAFLD if you’re Hispanic)

Diagnosing Fatty Liver Disease  

Fatty liver disease can be easy to miss, as many people don’t experience symptoms. If you get a liver function test for another reason, your healthcare provider might notice abnormal results and want to check for fatty liver disease.  

To start, your healthcare provider might ask you about your medical history. This may include questions about: 

• How much alcohol you drink

• Whether you take any medications

We know it can feel uncomfortable talking about your drinking habits, but it’s important to be honest here. 

Your healthcare provider isn’t here to judge — only to help you take charge of your health. They’ll need an accurate idea of how much alcohol you drink to help diagnose and treat fatty liver disease. 

Next, your healthcare provider might do a physical exam. This may include checking your eyes for signs of jaundice. They may feel your abdomen to see if it’s painful or enlarged.

Your provider may also order tests to help diagnose fatty liver disease. 

These tests may include: 

• Blood tests

• Imaging tests

• A liver biopsy

Fatty Liver Disease Treatment 

The type of treatment you need for fatty liver disease will depend on which type you have. The following are a few common treatments.

Weight Loss 

If you have overweight or obesity, your healthcare provider may recommend weight loss to help manage nonalcoholic fatty liver disease.   

Losing weight can help reduce steatosis (fat build-up), inflammation, and fibrosis (thickening or scarring in the liver). 

Research suggests that losing three to five percent of your body weight can improve fat build-up, while losing 10 percent can reduce liver inflammation. 

If you lose weight, you might find your NASH switches to NAFL — i.e., liver inflammation and damage improves, but you still have some fat build-up in your liver.

If you’ve struggled to keep weight off in the past, your provider may recommend weight loss medications.

These include:

• Semaglutide (Ozempic^®, Wegovy^®, Rybelsus^®) 

• Tirzepatide (Mounjaro^®, Zepbound^®, compounded tirzepatide) 

• Liraglutide (Victoza^® and Saxenda^®)

• Metformin 

• Topiramate 

Weight loss is highly individual, so your best bet is to speak with a healthcare provider who can give you personalized advice on achieving your goals — and what those goals should look like.

To reach your weight loss goals, you can also try: 

• Making healthy food choices. Reach for fruits, vegetables, lean protein, legumes, and whole grains like brown rice and whole-wheat bread. 

• Drinking less. Alcohol has lots of calories and contributes to weight gain.

• Getting more activity. Make regular activity a habit. This can be structured exercise like workout classes or general movement, like walking more each day.

• Drinking more water. Water can help you feel fuller and promote the breakdown of fat.

• Prioritizing sleep. Aim for seven to nine hours of sleep a night. Keeping a regular sleep schedule, drinking less caffeine, and maintaining a relaxing bedtime routine can help you get more shut-eye. 

Medication for Fatty Liver Disease 

Your healthcare provider may recommend medications for fatty liver disease. 

These include: 

• Metformin

• Vitamin E 

• Orlistat

• Pioglitazone  

In March 2024, the U.S. Food and Drug Administration (FDA) approved resmetirom — sold under the brand name Rezdiffra^® — for people with NASH and moderate to advanced liver scarring. 

In clinical trials, Rezdiffra helped improve liver scarring or resolve NASH after 12 months.

Weight loss injections like semaglutide have also been found to directly improve fatty liver disease. 

A 2023 systematic review examined three clinical trials including almost 460 participants with NAFLD. Findings suggest that semaglutide helped improve the participants’ liver health. 

Those taking semaglutide had a higher likelihood of their NASH resolving compared to those taking a placebo.

Semaglutide led to improvements in: 

• Liver stiffness

• Steatosis 

• Liver enzymes 

• Body weight

• A1C (a measure of blood sugar) 

Cutting Out Alcohol  

For alcoholic liver disease, treatment will include cutting out alcohol. 

You can do this by: 

• Getting support from a therapist, addiction specialist, or support group.

• Speaking to a healthcare provider about medication that can help curb alcohol cravings.  

• Quitting drinking together with a close friend or family member.

• Avoiding triggers — these might be certain places, people, or times you often drink. 

• Making lifestyle changes like finding a new hobby, playing a sport, or adopting a new workout routine. 

• Replacing alcoholic drinks with sparkling water or mocktails. 

Other Treatments

If your NAFLD is caused by a certain medication, you might be advised to stop this medication. Your healthcare provider will give you instructions on how to stop your medication and whether to start an alternative treatment. 

Depending on the severity of your condition, you may need further treatment. For example, fatty liver disease can lead to cirrhosis. Cirrhosis can cause serious health issues that require medication, surgery, or even a liver transplant.

Fatty Liver Disease Prevention Tips 

To reduce your risk of developing fatty liver disease, aim to maintain a healthy weight and limit your alcohol consumption. 

Other steps you can take include:

• Eating a healthy diet. Focus on eating mostly fruits, vegetables, legumes, fish, and whole grains. The Mediterranean diet and the DASH eating plan are good examples of healthy eating.  

• Getting regular physical activity. Aim for a mix of cardio and strength training.   

Staying on top of your health. See your primary care provider regularly to limit your fatty liver disease risk factors.