What is fatty liver disease?

Fatty liver is common, particularly in people with diabetes and who 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.

The fat in liver cells can build up. If there is too much, you have fatty liver.

Fatty liver is becoming more common throughout the Western world because we are eating too many added sugars and added fats.

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

What causes fatty liver disease?

Fatty liver can be caused by drinking too much alcohol over long periods. However, most people with fatty liver have ‘non-alcoholic fatty liver disease’, which is not caused by alcohol.

About 1 in 3 Australians has fatty liver. It is more common in people who:

• have high blood pressure
• have high cholesterol and high triglycerides
• have type 2 diabetes or look like they will develop it
• are overweight, especially around the abdomen

A few people have fatty liver due to other diseases, such as polycystic ovary syndrome (PCOS), chronic hepatitis B, chronic hepatitis C or haemochromatosis (a genetic abnormality of iron storage), or reactions to drugs such as kava or medicines such as steroids or chemotherapy.

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

How is fatty liver disease diagnosed?

Because fatty liver often does not cause any obvious symptoms, you may not know you have it until a routine test shows signs of a liver abnormality.

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 to see the health of your liver. You may also be asked to have a scan such as an ultrasound or 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 specialist (gastroenterologist). In severe cases, a specialist may organise a biopsy of your liver to confirm the diagnosis and assess how severe the disease is.

How is fatty liver disease managed?

There are no medicines to treat fatty liver disease. Treatment involves making changes to your lifestyle. This can improve the condition and even reverse it.

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.

If you have non-alcoholic fatty liver disease, you will probably be advised to:

• drink no or very little alcohol
• 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
• quit smoking

Your doctor can help you. They may refer you to a dietitian, drug and alcohol counsellor or specialist.

Avoiding all fat in your diet is not necessary. However, your doctor may recommend that you avoid certain foods, such as those that contain fructose (the sugar in fruit) and trans fats (a type of fat).

There is no specific medicine for fatty liver disease. However, depending on your situation, your doctor may advise that you take medicine to lower your lipid levels, or improve the way your body manages glucose.

Can fatty liver disease be prevented?

The way to prevent non-alcoholic 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
• being physically active on most days of the week — check with your GP first if you haven’t been exercising regularly

What are the complications of fatty liver disease?

In many people, fatty liver by itself doesn’t cause too many problems. But in some people the fatty liver gets inflamed, causing a more serious condition called non-alcoholic steatohepatitis, or NASH. Ongoing inflammation may scar the liver, which can lead to cirrhosis. This is a serious illness.

A few people who get cirrhosis of the liver develop 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

• Queensland Health: practical tips on how to prevent or manage fatty liver disease
• Hepatitis NSW: A healthy diet for fatty liver repair