Fatty liver

What is fatty liver?

Your liver is one of the most important organs in the body. It’s responsible for a whole range of things, including:

• Removing dangerous toxins from the body, such as alcohol or drugs

• Producing bile to help digest fats

• Regulating your blood sugar levels

• Helping the immune system function 

A healthy liver should usually contain little or no fat at all. But when a buildup of fat in your liver occurs, this can cause inflammation. The damage can mean it will not be able to function as normal. If this inflammation persists over many years, irreversible damage known as cirrhosis can develop.

What causes fatty liver?

The two most common types of fatty liver are non-alcoholic fatty liver disease and alcoholic liver disease. 

1. Non-alcoholic fatty liver disease  

The most common cause of a fatty liver is non-alcoholic fatty liver disease (NAFLD). Although the exact cause is unknown, NAFLD is thought to develop when the body can’t metabolise the fat efficiently or it produces too much fat.

The following factors can make you more at risk of developing NAFLD:

• Being obese or overweight 

• Having a condition that affects insulin in your body, including type 2 diabetes or polycystic ovary syndrome (PCOS) 

• Having metabolic syndrome (a trio of high blood pressure, obesity and diabetes)

• Having high blood pressure 

• Having underactive thyroid 

• Smoking

• Being over 50 years old

It’s estimated that up to a third of the population has early stages of the condition and usually they will be unaware of it. Early stages of the condition (known as simple fatty liver) are relatively harmless but damage over many years has the potential to cause cirrhosis. 

2. Alcohol-related fatty liver disease

Drinking too much alcohol can also result in fatty liver disease, known as alcohol-related fatty liver disease (ARLD). This can include drinking a large amount over a very short amount of time or drinking excess amounts over many years.

Our liver is responsible for processing the alcohol we drink but if we drink excessive amounts, our liver cells are damaged causing fatty deposits to form. Although these cells can regenerate, drinking alcohol over many years can impair the cell’s ability to do this and permanent damage and liver failure can occur. 

The following risk factors can make you even more likely to develop the condition:

• Being overweight or obese

• The condition running in your family (genetic component) 

• Having viral hepatitis (especially hepatitis C) 

How serious is a fatty liver?

The early stages of a fatty liver are relatively harmless. This is because liver cells have the ability to regenerate and so your liver function is maintained. 

If the cells are damaged over many years, the liver can become permanently scarred. This process is known as liver cirrhosis and can eventually lead to liver failure. 

Simple things such as reducing your alcohol intake and improving your diet can avoid these serious problems from developing. 

What are the key fatty liver symptoms?

The symptoms of a fatty liver can be difficult to spot, especially in the early stages. Symptoms will typically only develop when the liver has become significantly damaged. NAFLD and ARLD will present similarly and also cause similar complications. 

Early symptoms can include: 

• Upper right-hand side stomach pain – this is often dull and can be hard to locate 

• Weight loss or appetite loss that’s unexplained 

• Extreme tiredness 

• Nausea

• Feeling weak

Symptoms that indicate later stages of the disease and severe liver damage include:

• Yellowing of the skin and eyes (known as jaundice) 

• Itchiness 

• Abdominal bloating 

• Swollen legs and ankles (known as oedema) 

• Veins appearing on your tummy 

• Hair loss 

• Red palms 

• Confusion, memory and sleep problems 

How do I know if I have a fatty liver?

The symptoms of a fatty liver are easy to miss and therefore it’s often diagnosed incidentally. If your doctor suspects you may have a fatty liver, they will ask a few questions about your lifestyle including diet and alcohol consumption. You are likely to be advised to have blood tests to check how your liver is working. If these point towards a fatty liver, further imaging or a biopsy can be ordered to confirm the diagnosis. 

1. Liver function blood tests 

The levels of some proteins and enzymes can be analysed in order to assess the function of the liver and whether it has been damaged. For example: 

• Albumin – a protein that is produced by the liver. Low levels indicate decreased liver function. 

• Blood clotting proteins – abnormal blood clotting can be a sign of severe liver damage. 

However, blood tests will not always pick up NALD or ARLD so you might be advised to have a scan too.  

2. Imaging 

Doctors can use an ultrasound, CT or MRI scan to visualise the liver and determine if there has been any damage. An ultrasound scan is often the initial imaging used, as it's less invasive and involves no radiation. 

3. Biopsy 

If results are still inconclusive or a more detailed analysis of the liver damage is required, you may be advised to have a biopsy. This involves inserting a thin needle into the liver to get a sample, which can then be sent to the laboratory for analysis. 

How is fatty liver treated?

ARLD 

There is no treatment for ARLD but the most important thing to do is to stop drinking alcohol. By reducing your alcohol intake to zero, you can give your liver cells the chance to regenerate. 

This process can be incredibly difficult as many people with the condition are dependent on alcohol. Speak to a GP about your local alcohol support services, who will be able to help and support you. 

If your condition has progressed to a more advanced stage, such as cirrhosis or liver failure, a liver transplant may be required. 

NAFLD 

There are no medications that can currently treat or reverse NAFLD, but your doctor may recommend lifestyle changes to prevent your condition from worsening. You may also be advised to start medications to treat any type-2 diabetes, high blood pressure or high cholesterol that you may have. 

Most people with NAFLD do not develop any serious problems but, if cirrhosis develops a liver transplant may be recommended.

How can I help to prevent or improve a fatty liver?

The best way to achieve this is by making changes to your lifestyle. This can involve: 

• Eating a balanced, healthy diet – try to have a mix of fruit, vegetables, proteins and carbohydrates while reducing your sugar and fat intake 

• Exercise regularly – try to get up to 150 minutes of moderate activity (where your heart rate is slightly elevated) 

• Stop or reduce your alcohol intake to the recommended amounts 

• Stop smoking

When should I speak to a doctor?

If you think you have a fatty liver, you should see a doctor. In particular, look out for:

• Unexplained weight loss

• Severe right stomach pain 

• Any signs of later-stage liver disease including yellowing of your skin or eyes, itchiness, abdominal bloating, swollen legs and ankles, veins appearing on your tummy, hair loss, red palms and confusion.