Fatty Liver Disease (Hepatic Steatosis)

What is Fatty Liver Disease?

Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis.

Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work.

But you can get fatty liver disease even if you don’t drink a lot of alcohol.

Nonalcoholic Fatty Liver Disease (NAFLD)

There are two different types of nonalcoholic fatty liver disease:

Simple fatty liver: This means you have fat in your liver, but you may not have any inflammation in your liver or damage to your liver cells. It usually doesn’t get worse or cause problems with your liver. Most people with NAFLD have simple fatty liver.

Nonalcoholic steatohepatitis (NASH): This is much more serious than a simple fatty liver. NASH means you have inflammation in your liver. The inflammation and liver cell damage that happen with NASH can cause serious problems such as fibrosis and cirrhosis, which are types of liver scarring, and liver cancer. About 20% of people with NAFLD have NASH.

Alcohol-Related Fatty Liver Disease (ALD)

Alcoholic fatty liver disease is preventable. It usually gets better when you stop drinking alcohol. If you keep drinking, ALD can cause serious problems. These include:

  • Enlarged liver. It doesn’t always cause symptoms, but you may have pain or discomfort on the upper right side of your belly.
  • Alcoholic hepatitis. This is swelling in the liver that can cause fever, nausea, vomiting, belly pain, and jaundice (yellowish skin and eyes).
  • Alcoholic cirrhosis. This is a buildup of scar tissue in your liver. It can cause the same symptoms as alcoholic hepatitis plus:

Alcohol-related fatty liver disease usually comes first. It can then get worse and become alcoholic hepatitis. Over time, it may turn into alcoholic cirrhosis.

If you drink heavily, talk with your doctor. It’s confidential, and they can help you get your drinking under control to save your health.

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Symptoms of Fatty Liver Disease

With ALD and NAFLD, there are usually no symptoms. Some people may have signs such as tiredness or pain in the upper right side of the belly where your liver is.

If you have NASH or get cirrhosis, you may have symptoms such as:

  • Swollen belly
  • Enlarged blood vessels underneath your skin
  • Larger-than-normal breasts in men
  • Red palms
  • Skin and eyes that appear yellowish, due to a condition called jaundice

Causes and Risk Factors

For ALD, the cause is too much alcohol. You may be even more likely to get it if you drink a lot and

  • Are obese
  • Are malnourished
  • Have chronic viral hepatitis, especially hepatitis C
  • Have genes that make you more likely to get it
  • Are an African-American or Hispanic male
  • Age -- the older you are, the more likely it becomes.

The reason why some people with NAFLD have simple fatty liver and others get NASH isn’t known. Genes may be a reason. NAFLD or NASH is more likely if:

There are also some less common reasons why you may get NAFLD or NASH. They include:

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Diagnosis

Because most people don’t have symptoms, these conditions aren’t easy to diagnose.

Your doctor may use different methods to find out if you have fatty liver disease. Some of the things your doctor may use to diagnose fatty liver disease are:

  • Health history. Your doctor will ask about your alcohol use. This information can help your doctor tell if you have ALD or NAFLD, so be truthful. He’ll also ask about medications you take, how you eat, and other health conditions you might have.
  • Physical exam. Your doctor weighs you and checks your body for signs of liver problems such as an enlarged liver or jaundice.
  • Blood tests. These can show if you have high levels of liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If so, there could be a problem with your liver.
  • Imaging tests . You may get an ultrasound, computerized tomography (CT) scans, or magnetic resonance imaging (MRI). These tests can help show if there’s any fat in your liver. But they can’t tell whether you have simple fatty liver or NASH
  • Liver biopsy. Not everyone with NAFLD needs to have a liver biopsy. Your doctor may recommend it if you’re at risk for NASH or if other tests show that you may have NASH complications such as cirrhosis. A doctor removes a sample of tissue from your liver and sends it to a lab to see if you have liver inflammation or damage. You’ll get this done at a hospital or outpatient surgery center. Before the procedure, you’ll get medicine to help you relax or control pain. For the biopsy, your doctor numbs the area and uses a special needle to take a small piece of tissue from your liver. A liver biopsy is the only way for doctors to diagnose NASH.

Treatment for Fatty Liver Disease

There are no medications approved for NAFLD, though some are in clinical trials.

Usually the first line of treatment is to lose weight. It helps reduce fat, inflammation, and scarring in your liver. Losing just 3% to 5% of your body weight can cut down on how much fat is in your liver. Weight loss surgery is also an option if you have a lot to lose.

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You’ll also need to quit drinking. It’s the only way you can keep liver damage from getting worse. You may even be able to undo some of the liver damage that’s already happened. Talk to your doctor about how you can get help. You may need a medically supervised detox program to safely quit drinking and manage withdrawal symptoms.

If you have complications due to NASH, such as cirrhosis or liver failure, you may need to have a liver transplant. In general, people with NASH who get a liver transplant do very well.

Self-Care for Fatty Liver Disease

Lifestyle changes can help:

  • Exercise more. Try to be active at least 30 minutes a day most days of the week. If you're trying to lose weight, you might find that it helps to exercise more. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
  • Be kind to your liver. Don’t do things that will make it work harder. Skip alcohol. Take medications and over-the-counter drugs only as instructed. Talk to your doctor before you try any herbal remedies. Just because a product is natural, that doesn’t mean it’s safe.
  • Get your cholesterol down. Eat a healthy plant-based diet, exercise, and take your medications. This will get -- and keep -- your cholesterol and your triglyceride levels where they need to be
  • Manage your diabetes. Check your blood sugar, and take medications as your doctor prescribes.

Complications of Fatty Liver Disease

The main complication for all these conditions is cirrhosis, or scarring of your liver. As your liver tries to stop the inflammation that comes with these conditions, it creates areas of scars. As inflammation spreads, so do the scars, and eventually, your liver can’t do its job. That can result in:

  • Fluid buildup in your abdomen
  • Swollen veins in your esophagus that can burst and bleed
  • Confusion and drowsiness
  • Liver cancer
  • Liver failure

Can You Prevent Fatty Liver Disease?

To prevent ALD:

  • Drink in moderation: That’s one drink a day for women and men over 65 and up to two for men 65 and younger.
  • Protect yourself from hepatitis C: This viral liver infection can make you more likely to get cirrhosis if you drink.
  • Check before you mix meds and alcohol: Ask your doctor if it’s OK to drink alcohol with the prescription medications you’re taking. Read the warning label on over-the-counter meds. Don’t drink when you’re taking products like acetaminophen, which can damage your liver when combined with alcohol.

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For NAFLD and NASH, It boils down to making better choices:

  • Eat healthy food. Choose a plant-based diet with lots of fruits, vegetables, whole grains, and healthy fats.
  • Stay at a healthy weight. Lose weight if you need to. If your weight is healthy, work to maintain it by choosing a healthy diet and exercising.
  • Exercise. Get a workout most days of the week. Talk to your doctor first if you haven't been active in a while.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on September 04, 2019

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts of NAFLD & NASH,” “Cirrhosis,” “Symptoms & causes of NAFLD & NASH,” “Diagnosis of NAFLD & NASH,” “Treatment for NAFLD & NASH,”

American Liver Foundation: “Alcohol-Related Liver Disease.”

Mayo Clinic: “Nonalcoholic Fatty Liver Disease,” “Alcoholic hepatitis.”

American Academy of Pediatrics: “Nonalcoholic Fatty Liver Disease: Diagnosis and Management.”

Cleveland Clinic: “Ascites.”

Clinical Trials.gov: “A Study of Pemafibrate in Patients With Nonalcoholic Fatty Liver Disease (NAFLD),” “Nonalcoholic Fatty Liver Disease (NAFLD) Pharmacological Treatment: Metformin Versus Atorvastatin,” “Treatment for Non-Alcoholic Fatty Liver With Different Doses of Vitamin E.”

UpToDate: “Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults.”

News release, Mayo Clinic.

University of Michigan Medicine: “Alcoholic Liver Disease.”

Current Opinion in Gastroenterology: “Aging and liver disease.”

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