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)

Like the name says, alcohol isn’t involved in this condition. Instead, it results largely from metabolic syndrome, an umbrella term for a condition marked by high blood pressure, high levels of bad cholesterol, insulin resistance, and large amounts of belly fat.

There are different types of NAFLD.

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. You may also have damage to your liver cells. The inflammation and liver cell damage that happen with NASH can cause serious problems such as:

  • Fibrosis: scarring of the liver
  • Cirrhosis: severe scarring in the liver, which can lead to liver failure and death
  • Liver cancer

About 20% of people with NAFLD have NASH.

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Alcohol-Related Fatty Liver Disease (ALD)

You might hear this called “ALD.”

Some people don’t have any symptoms. But if your liver becomes enlarged, you may have pain or discomfort on the upper right side of your belly.

ALD is preventable. It usually gets better when you stop drinking alcohol.

If you keep drinking, ALD can cause serious problems. These include:

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:

  • Large amounts of fluid buildup in your belly (the doctor will call it ascites)
  • High blood pressure in the liver
  • Bleeding in your body
  • Confusion and changes in behavior
  • Enlarged spleen
  • Liver failure, which can be fatal

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.

Symptoms

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

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:

  • You’re overweight or obese
  • Your body doesn’t respond to insulin as it should (called insulin resistance) or if you have type 2 diabetes
  • You have high levels of triglycerides or “bad” (LDL) cholesterol, or low levels of “good” (HDL) cholesterol
  • You have metabolic syndrome. This is a mix of conditions that make you more likely to get type 2 diabetes and heart disease.

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With metabolic syndrome, you may have any three of these conditions:

  • Large waist size
  • High triglycerides or LDL cholesterol
  • Low levels of HDL (good) cholesterol
  • High blood pressure
  • High blood sugar

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

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.

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Treatment and Remedies for Fatty Liver Disease

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

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.

Quitting drinking can help with ALD. 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.

Lifestyle changes can help with NAFLD:

  • Lose weight. This is one of the best treatments for NAFLD. Weight loss 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.
  • 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.

WebMD Medical Reference Reviewed by Linda Bernstein, PharmD on December 16, 2018

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.”

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.”

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