What is fatty liver disease?

Fatty liver is when there is too much fat in your liver. It’s common, particularly in people who have diabetes and are overweight. Although it might not cause any symptoms, it can lead to significant health problems. Making changes to your lifestyle is key to preventing and improving the condition.

The liver is the body’s main organ for processing food and waste materials.

A healthy liver contains very little or no fat. If you drink too much alcohol, or eat too much food, your body deals with this excess by turning some of the calories into fat. This fat is then stored in liver cells.

When fat makes up more than 5% to 10% of the total weight of your liver, you have fatty liver.

Fatty liver is becoming more common as people eat more added sugars and added fats. About 1 in every 3 Australian adults has fatty liver disease.

What are the symptoms of fatty liver disease?

Fatty liver disease usually doesn’t cause symptoms. People who have symptoms may:

• feel tired or generally unwell
• have pain in the upper right part of their abdomen
• lose weight

Signs that you may have more serious fatty liver disease include:

• yellow eyes and skin (jaundice)
• bruising
• dark urine
• swollen tummy
• vomiting blood
• black stools (poos)
• itchy skin

See your doctor if you have any of these symptoms.

What causes fatty liver disease?

Fatty liver is usually due to a combination of factors over a long period of time.

The most common causes of fatty liver are:

• being obese or overweight especially around the abdomen (tummy)
• having type 2 diabetes mellitus or insulin resistance
• having high blood cholesterol or high triglycerides
• drinking too much alcohol

Less common causes are:

• an underactive thyroid
• certain medicines
• having polycystic ovary syndrome (PCOS)

Some people can also get fatty liver because of complications that develop late in pregnancy.

There are 2 main types of fatty liver disease:

1. metabolic associated fatty liver disease
2. alcohol-related fatty liver disease

These have different causes.

Metabolic associated fatty liver disease

Metabolic associated fatty liver disease is the most common type of fatty liver disease. This has also been known as:

• non-alcoholic fatty liver disease
• non-alcoholic hepatic steatosis

This type of fatty liver disease is caused by:

• being overweight or obese
• not being active enough

Alcohol-related fatty liver disease

Alcohol-related fatty liver disease is caused by drinking too much alcohol over long periods.

You are at risk of fatty liver disease related to alcohol if you:

• drink more than 10 standard drinks a week
• binge drink (have more than 4 standard drinks in a day)

When should I see my doctor?

Fatty liver often does not cause obvious symptoms. So, you may not know you have it until a routine test shows signs of a liver problem.

Learn more about health checks you need as you age.

How is fatty liver disease diagnosed?

Your doctor will diagnose fatty liver by talking to you first, then examining you.

You may be asked to have a blood test called a liver function test. This will check the health of your liver. You may also be asked to have a scan such as:

• an ultrasound
• an MRI scan

If the tests show you have fatty liver, you may need some other tests to look further into your health.

Depending on the results of the tests, your doctor may suggest that you see a gastroenterologist (specialist doctor). In severe cases, a specialist may organise a biopsy of your liver to confirm the diagnosis. This will also help them assess how severe the disease is.

How is fatty liver disease treated?

There are no medicines to treat fatty liver disease.

Management involves making changes to your lifestyle. This can improve the condition and even reverse it.

If you have metabolic associated fatty liver disease, you will probably be advised to:

• follow a healthy diet and avoid sugar
• lose weight
• exercise regularly
• control your blood sugar
• treat high cholesterol if you have it
• avoid medicines that can affect your liver
• drink no or very little alcohol, and quit smoking

If your fatty liver is caused by alcohol, then the most important thing to do is give up alcohol. This will prevent you from developing a more serious condition.

Your doctor may refer you to a dietitian, drug and alcohol counsellor or specialist for further information.

Can fatty liver disease be prevented?

The way to prevent metabolic associated fatty liver disease is to follow the same lifestyle advice given to people who already have the condition, including:

• eating a healthy diet that is rich in fruit and vegetables, whole grains and healthy fats
• maintaining a healthy weight
• drinking no or very little alcohol
• being physically active on most days of the week

If you haven’t been exercising regularly, speak with your doctor first.

Complications of fatty liver disease

In many people, fatty liver by itself doesn’t cause too many problems at first.

It can worsen slowly over time. The extra fat in the liver causes liver inflammation, which eventually leads to scarring (fibrosis) of the liver. It may also lead to more serious chronic liver disease, such as cirrhosis or liver cancer.

Some people who develop severe cirrhosis of the liver need to have a liver transplant.

People with fatty liver have an increased risk of heart attack and stroke.

Resources and support

You can read more about your liver and liver diseases at the Liver Foundation website, or call their free support line on 1800 841 118 to speak to a liver nurse.

The Gastroenterological Society of Australia GESA has information on fatty liver disease. These are available in English, Arabic, Chinese (simplified), Chinese (traditional), and Vietnamese.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.