What is fatty liver disease?

Fatty liver is when there's too much fat in your liver. Your 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 turns some of the calories into fat. This fat is stored in your liver cells.

You have fatty liver when fat makes up more than 5% of the total weight of your liver.

Over time fatty liver can lead to cirrhosis (scarring).

It's common, about 1 in every 3 Australian adults has fatty liver disease.

There are 2 main types of fatty liver disease:

1. metabolic associated fatty liver disease (MAFLD)
2. alcohol-related fatty liver disease

Metabolic associated fatty liver disease is the most common type of fatty liver disease. This used to be called non-alcoholic fatty liver disease (NAFLD).

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

What are the symptoms of fatty liver disease?

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

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

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

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

What causes fatty liver disease?

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

The most common causes of fatty liver are:

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

Less common causes of fatty liver are:

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

Some people can also get fatty liver in pregnancy. Acute fatty liver of pregnancy (AFLP) is a rare complication. It may happen in the third trimester or soon after birth.

When should I see my doctor?

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

See your doctor if you have signs of more serious liver disease.

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 some blood tests including a liver function test. You may also be asked to have a scan such as:

• an ultrasound
• a CT scan
• an MRI scan

Your doctor may refer you to a gastroenterologist (a doctor who specialises in treating the digestive system).

You may need to have a biopsy of your liver. This will also help your doctor see how much fat has built up.

How is fatty liver disease treated?

Making changes to your lifestyle can improve fatty liver and even reverse it.

If you have MAFLD, you will 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 or vaping

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

Medicines for fatty liver disease

There are no medicines to treat fatty liver disease.

Other treatment options

Depending on the cause of your fatty liver, your doctor may refer you to a:

• dietitian
• exercise physiologist
• psychologist
• drug and alcohol counsellor

What are the complications of fatty liver disease?

People with fatty liver disease have a greater chance of:

• heart problems
• stroke
• kidney disease

The extra fat in your liver causes liver inflammation, which leads to fibrosis (scarring) of the liver. It may lead to cirrhosis. Which can in turn lead to liver cancer.

Some people will need a liver transplant.

Can fatty liver disease be prevented?

To prevent fatty liver disease, follow the same lifestyle advice given to people with the condition. This includes:

• 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.

Resources and support

You can read more about liver diseases at the Liver Foundation website. You can 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.

Read the NHMRC Alcohol Guidelines for trusted information on reducing the risk of alcohol.

You can also use these calculators to work out how much you are drinking:

• Standard Drink Calculator by Your Room
• How much are you really drinking? by The Right Mix

If you need support to lower your alcohol use, you can visit your doctor or local community health service. You can also:

• visit the Alcohol and Drug Foundation website
• call the National Alcohol & Other Drug Hotline on 1800 250 015
• try The Daybreak App, by Hello Sunday Morning, which can support you to change your relationship with alcohol
• contact Alcoholics Anonymous Australia on 1300 222 222

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.