Learn more about hepatic steatosis (fatty liver), including its signs and symptoms, stages, causes, diagnosis, complications, prevention and treatment.

What Is hepatic steatosis (fatty liver)?

Hepatic steatosis is also known as fatty liver disease. It can happen for several reasons, and occurs when there is a build-up of fat within the liver.

A healthy liver should contain very little fat, but in some people, fat cells begin to accumulate in the tissues of the liver. Fatty liver disease is on the rise, and closely follows levels of obesity within a population.

Alcoholic fatty liver disease

Heavy drinkers are at very high risk of developing alcoholic fatty liver disease. When someone with a high alcohol intake develops a fatty liver and does not stop drinking, their liver may go on to develop cirrhosis, where healthy liver tissue is replaced by scar tissue, and alcoholic hepatitis, a condition where inflammation of the liver prevents it from working properly.

Fatty liver that is caused by heavy drinking can improve by stopping drinking, but extensive existing liver damage cannot be reversed.

Non-alcoholic fatty liver disease

Although liver damage is often thought of as a condition that only affects heavy drinkers, some people develop fatty liver for other reasons, and sometimes it isn’t easy to pinpoint a cause. Non-alcoholic fatty liver disease (NAFLD) is much more common in people who are overweight or obese than those who maintain a healthy weight.

Non-alcoholic fatty liver disease is divided into two main types:

Simple fatty liver

A condition where there are fat deposits within the liver, but there is no inflammation and may be no symptoms. Blood tests or medical imaging can point to a fatty liver, and an early diagnosis means a better chance for improving the condition, or stopping it from progressing.

Non-Alcoholic Steatohepatitis (NASH) or Non-Alcoholic Hepatic Steatosis

NASH is a potentially serious condition where a fatty liver is also inflamed. This combination can lead to the development of fibrosis – the early formation of some scar tissue which may begin to affect liver function – and cirrhosis, permanent scarring to the liver tissues which seriously affects the liver function.

Fatty liver symptoms

In the early stages, a fatty liver usually does not cause symptoms. At this stage it is usually only discovered during tests for other conditions, such as routine blood tests or medical imaging.

As fatty liver disease progresses, the liver begins to develop fibrosis – the beginnings of scar tissue deposits which can affect liver function and cause symptoms like tiredness, pain in the right upper abdomen, and can sometimes cause weight loss.

The next stage is cirrhosis of the liver, which can cause serious problems like jaundice, where the skin and whites of the eyes become more yellow in colour as the liver fails to remove all the waste products from the blood.

Liver cirrhosis also causes oedema, which is fluid retention and swelling, usually in the legs and feet, and ascites, where free fluid in the abdomen causes a swollen, painful tummy.

Fatty liver causes

Alcoholic fatty liver disease is directly caused by a high alcohol intake. As continued heavy drinking makes the condition progress, it is most often seen in middle-aged or older adults, although it can affect much younger people who are heavy drinkers.

Fatty liver risk factors

Alcoholic fatty liver disease is caused by heavy drinking, so the highest risk factor for the condition is a high alcohol intake.

Around 20 per cent of alcoholics and heavy drinkers develop fatty liver disease, and the more a person drinks, the higher their likelihood of causing liver damage. This is just one of the conditions that can be linked to a high alcohol intake so it’s important to stay within the recommended limits.

The risk factors for non-alcoholic fatty liver disease include:

• Being overweight or obese
• Having type 2 diabetes – a condition also linked to being overweight
• Dyslipidaemia – abnormal levels of fats in the blood. This is also linked to being overweight.

These risk factors for NAFLD also increase the risk of other serious conditions like heart disease and stroke.

Some less common risk factors for NAFLD include certain medications, extreme rapid weight loss, hepatitis C infection, and coeliac disease.

How serious is a fatty liver?

A fatty liver in itself may have no symptoms, and even have minimal impact on liver function. However, the likelihood that it will progress to more serious liver damage should be considered, and so fatty liver disease needs to be taken seriously.

Some of the conditions that are linked to fatty liver can also be very serious, so it’s important to carefully manage any other conditions.

Taking steps to help a fatty liver recover can have a profound effect on the progress – in some cases, fatty liver disease may be completely reversible. If these steps aren’t taken, however, a fatty liver can progress into serious liver damage, even liver failure and contribute to multi-organ failure.

Some people with severe liver disease may even need to have a liver transplant. A diagnosis of fatty liver can be a wake-up call to improve a lifestyle and prevent serious problems.

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Fatty liver complications

Having a fatty liver does not usually cause symptoms or problems in the early stages, but it can begin to cause serious problems if it progresses into more serious liver damage and scarring. Scar tissue build-up – cirrhosis – causes serious complications, including:

• Portal hypertension
• Bleeding in the digestive tract
• Oedema – fluid build-up in the body
• altered mental state
• Jaundice
• High levels of toxins in the blood
• Liver failure

Severe cirrhosis of the liver also increases the risk of liver cancer. A diagnosis of fatty liver is a chance to reduce serious risk.

Fatty liver diagnosis

As fatty liver rarely causes problems until it progresses to a more serious phase, it is usually only found incidentally during investigations for unrelated symptoms.

Medical imaging scans like ultrasounds and CT scans of the abdomen may show a fatty liver, and a doctor may be able to feel an enlarged liver during an abdominal examination. Sometimes, blood tests for liver function may show some abnormalities, but having a fatty liver does not necessarily cause any changes in liver function that show up on blood tests.

If there is any doubt about the diagnosis, a biopsy can give a definite answer – a tiny sample of liver tissue is taken with a fine needle inserted through the abdomen, and examined in a laboratory.

Is fatty liver curable?

If a fatty liver is found before it causes any other problems, it usually be well managed with some healthy lifestyle changes. Other conditions that contribute to or are related to fatty liver need to be carefully managed, such as pre-existing diabetes or cardiovascular disease.

The liver is very good at regenerating tissue and can heal well with a healthy lifestyle – if it isn’t already too damaged. A fatty in the early stages can heal well; liver disease which has progressed to cirrhosis does not have as good a chance of improvement.

Reversing fatty liver

We can do a lot to improve a fatty liver just by making healthy changes in our lifestyles – a strict diet with lots of fruit and vegetables, whole grains and lean protein, and avoiding high fat dairy or meat products can make a big difference. 

Following a sensible exercise regime is also essential for improving fatty liver. Making these changes isn’t always easy, but people who are overweight or obese, or who have unhealthy diets or get little exercise are at risk of a range of serious health conditions.

Help and advice are available for those looking to improve their diet and lifestyle, and a GP can help point you in the right direction.

Fatty liver diet

A healthy diet, combined with plenty of exercise is essential for stopping the progression of NAFLD, and for reducing the risk of lots of other conditions. A good diet for NAFLD should be especially low in fat, particularly animal fats like high fat dairy and fatty meat, and high in:

Fruit and vegetables

Fresh, frozen, or tinned (not in syrup), fresh vegetables and fruit should make up the largest part of a diet. Getting lots of plants in your diet is a good way to get a wide range of vitamins and minerals without excess calories.

Low fat dairy or fortified dairy alternatives

High in calcium and vitamins, dairy or fortified alternatives are an important part of a balanced diet.

Good fats

We don’t need a lot of fat in our diet, but a little is important – we get good fats from unsaturated vegetable oils like olive oil, from nuts and seeds, and oily fish.

Wholegrains

Choosing wholegrain products instead of more refined ‘white’ grains adds fibre and other nutrients – essential for all round health and gut health in particular.

Lean Proteins

Choosing lean meats, fish, legumes like lentils, nuts and beans is a great way to get protein without too much fat.

Avoiding sugary juices and fizzy drinks helps maintain a low weight and reduced empty calories in the diet. Simple sugars in the diet directly cause higher body fat levels.

Having a low alcohol intake is very important for anyone with liver disease.

Fatty liver home remedies

Maintaining a healthy weight, diet and exercise, and having a minimal alcohol intake are the best proven ways to manage fatty liver and liver disease risk at home. Although lifestyle changes sound simple, they aren’t a quick fix, and it takes some work to lose weight and follow a diet and exercise regime.

There isn’t any proven home remedy apart from a healthy lifestyle, although there is some evidence that meal timing can make a difference – particularly avoiding eating large meals later in the day.

Fatty liver treatment

The best way to treat a fatty liver is by making healthy lifestyle changes. It isn’t always easy to make these changes – changing your diet, exercise regime and alcohol intake can be difficult, but it’s okay to ask for help. There are lots of programmes and support groups to help people get healthier.

There isn’t a lot of evidence for medications that help with fatty liver disease, but treating other conditions that can contribute to or exacerbate fatty liver is very important.

Managing risk factors like type 2 diabetes, hypertension, and dyslipidemia (abnormal levels of fats in the blood) can help to reduce the risk of fatty liver disease progressing.

Giving up alcohol can cause serious withdrawal symptoms and very heavy drinkers should seek medical advice when they stop drinking alcohol.

How to prevent fatty liver

Knowing our risk factors for fatty liver can help us to manage and modify our risk. The first thing we need to do to prevent fatty liver is to follow a healthy lifestyle: maintain a healthy weight, exercise regularly, and eat healthy foods.

A healthy lifestyle also includes managing our alcohol intake. People with a high alcohol intake are at the highest risk of alcohol-related fatty liver and more serious forms of liver disease, so the best thing we can do to protect our livers from alcohol—related liver disease is to keep our alcohol intake to a minimum.

Fatty liver and pregnancy

Occasionally, a fatty liver can develop as a side-effect of pregnancy. It is rare – less than 1 in 10,000 pregnancies are affected by fatty liver disease, but when it does occur, it can cause serious complications.

Fatty liver in pregnancy has a high risk of mortality for both mother and baby. It usually occurs towards the end of pregnancy, and requires intensive medical management.

Now that you understand the risk and the things you can do to treat and reverse fatty liver, it is always important to maintain a healthy lifestyle – eating clean and exercising regularly, to avoid such disease and its complications. It’s cliché, but prevention is always better than cure.

This article was first published in Homage.