Fatty Liver Disease: Causes, symptoms, prevention, and nutrition tips
Fatty Liver Disease is also known as hepatic steatosis, and you might be interested to know that it’s becoming increasingly common.
In fact, in the UK, it’s estimated that around one in three adults has early-stage non-alcoholic fatty liver disease (NAFLD).
In 2023, NAFLD was renamed Metabolic dysfunction-associated steatotic liver disease (MASLD) due to its association with type 2 diabetes, obesity, and heart disease.
So, what is it?
Fatty liver disease is a condition where excess fat accumulates in the liver. It’s characterised by an abnormal buildup of fat in the liver cells, which can be caused by factors like alcohol consumption, obesity, diabetes, and other metabolic conditions.
Early-stage fatty liver disease can be a silent condition. It often won’t have serious symptoms. However, it can lead to complications if it’s left unmanaged, including inflammation, potential scarring, and long-term liver damage.
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Different types of fatty liver disease
There are two types of fatty liver disease:
- Non-alcoholic fatty liver disease (NAFLD): As the name suggests, NAFLD is not related to alcohol consumption. However, it’s often linked to obesity, metabolic syndrome, and diabetes.
- Alcoholic fatty liver disease: This one is caused by excess alcohol consumption. Alcohol disrupts fat metabolism, leading to fat accumulation in the liver.
There are also different stages of fatty liver disease.
Simple fatty liver (Steatosis): This is early-stage fatty liver disease. It’s characterised by a buildup of fat in the liver cells, which may not cause any symptoms or damage.
Nonalcoholic steatohepatitis (NASH): This is a more advanced form of the condition. At this stage, the liver becomes inflamed, potentially leading to scarring (fibrosis). If left untreated, cirrhosis or cancer can develop.
Causes and risk factors of fatty liver disease
Now that you’ve got to grips with the different types and stages of fatty liver disease, you might be wondering what contributes to its development.
Genetics can play a role. Research shows that certain populations with higher levels of specific genetic variants, such as the PNPLA3 I148M mutation, have increased rates of non-alcoholic fatty liver disease.
However, several other factors can increase your risk of developing fatty liver disease.
Obesity
Obesity is a significant risk factor for non-alcoholic fatty liver disease. In fact, non-alcoholic fatty liver disease is notably higher among individuals with obesity than those of a healthy weight.
Research suggests that among those with obesity, around 43% have non-alcoholic fatty liver disease. Around 33% have non-alcoholic steatohepatitis, a more severe form of liver inflammation.
There are several reasons why obesity contributes to fatty liver disease. Excess adipose tissue in obese individuals leads to more free fatty acids in the bloodstream.
In turn, these free fatty acids are taken up by the liver, increasing fat accumulation.
What’s more, obesity is associated with insulin resistance, a condition where the body’s cells no longer respond properly to insulin.
This leads to increased conversion of carbohydrates into fatty acids, contributing to a build-up of fat.
Add to that, obesity contributes to chronic inflammation, which can exacerbate the accumulation of fat in the liver.
Type 2 diabetes and insulin resistance
Type 2 diabetes and insulin resistance can also contribute to the development of non-alcoholic fatty liver disease.
In fact, studies show that around 50% of people with type 2 diabetes have the condition.
Why is this the case?
Insulin resistance leads to elevated levels of free fatty acids in the bloodstream.
As you’ve just read, the liver takes these up, and in a vicious cycle, this further increases insulin resistance.
It’s also associated with mitochondrial dysfunction. This reduces the liver’s capacity to oxidise fatty acids, which in turn promotes fat accumulation.
High cholesterol and triglycerides
Elevated levels of cholesterol and triglycerides can lead to excessive liver fat too. This is because the liver is responsible for processing fats and removing excess cholesterol from the bloodstream.
Too much fat can overwhelm the liver, and when this happens, the liver will start storing it within its cells.
Meanwhile, elevated triglycerides can form dense LDL ‘bad’ cholesterol particles, which deposit fat in the liver.
Sedentary lifestyle
Daily movement is important because a sedentary lifestyle can increase your risk of fatty liver disease.
The body’s ability to burn fat efficiently is impaired without regular physical activity, which can increase the likelihood of fat accumulation in your liver.
Physical activity helps regulate the metabolism of fats and sugars in your body. It also improves inulin sensitivity and reduces inflammation.
Studies show people who are inactive are more likely to develop non-alcoholic fatty liver disease, especially when combined with other risk factors like obesity and poor diet.
Poor diet
It might not come as a surprise that nutrition affects your risk of developing fatty liver disease.
Diets high in refined carbohydrates, trans fats, and added sugars can lead to increased fat accumulation in the liver.
Refined carbohydrates can cause rapid blood sugar spikes, triggering an increase in insulin production.
Over time, high insulin levels can promote fat storage in the liver and elsewhere in the body. Meanwhile, trans fats can contribute to inflammation and disrupt fat metabolism in the liver.
Alcohol consumption
Excessive alcohol consumption is another well-known cause of alcoholic fatty liver disease. (The clue’s in the name!)
When alcohol is metabolised by the liver, it produces toxic byproducts that can damage liver cells.
It also increases the production of fatty acids and disrupts normal fat metabolism.
Consuming too much alcohol over time can cause fatty liver disease to progress into more severe conditions. For example, alcoholic hepatitis or cirrhosis.
In the UK, it’s estimated that around one in three adults has early-stage fatty liver disease.
Signs and symptoms of fatty liver disease
As you’ve just learned, fatty liver disease, in its early stages, often has few or no symptoms.
You might not experience any symptoms until the disease progresses into non-alcoholic steatohepatitis.
However, there are a few symptoms that could suggest the presence of fatty liver disease.
Fatigue
Fatigue can be caused by many things, including fatty liver disease. If you have fatty liver disease, you might feel tired and sluggish, even after a full night’s rest.
This is because the liver plays an important role in energy metabolism, and when it’s compromised, it can lead to feelings of low energy and tiredness.
Abdominal pain
Fatty liver disease can also present as abdominal pain or discomfort. This is felt in the upper right side of the abdomen, where the liver is located.
When fat accumulates, the liver becomes enlarged, causing a dull ache.
Unexplained weight loss
Weight loss without an obvious cause may suggest that fatty liver disease has progressed into a more serious condition, like cirrhosis.
Weight loss occurs because of the liver’s decreased ability to process nutrients and maintain proper metabolic function.
If liver damage worsens, it can contribute to poor appetite and malnutrition too.
Jaundice
Jaundice (i.e. the yellowing of the skin and eyes) occurs when the liver becomes so damaged it can no longer process bilirubin.
Bilirubin is a waste product from the breakdown of red blood cells. When it builds up, it can cause the skin and whites of the eyes to turn yellow.
Swelling
Another symptom of fatty liver disease is swelling, typically in the abdomen, legs, and ankles.
As fatty liver disease advances to cirrhosis, a condition called ascites can develop. This is characterised by the liver’s inability to produce the protein albumin, which keeps fluid in the bloodstream.
Ascites can cause significant bloating and discomfort, as well as difficulty breathing.
Meanwhile, swelling in the legs and ankles can occur because of fluid retention.
How fatty liver is diagnosed
Fatty liver disease can be diagnosed in many different ways.
Given that it often doesn’t have symptoms in the early stages, a diagnosis for fatty liver disease sometimes occurs during check-ups or investigations for other health concerns.
Some tests used to diagnose fatty liver disease include:
Medical history and physical examination:
Your doctor will assess risk factors like obesity, diabetes, and alcohol use. They may check for physical signs of liver problems, like jaundice or abdominal tenderness.
Blood tests:
Blood tests measure liver enzymes (ALT, AST, GGT) to detect liver inflammation or damage. Elevated levels suggest liver issues, but they cannot confirm fatty liver disease on their own.
Ultrasound:
A common, non-invasive imaging test that uses sound waves to detect fat in the liver. It’s effective for diagnosing fatty liver disease but less precise for determining disease severity.
MRI and CT scans:
These tests can provide detailed liver images and measure fat content, but they’re less commonly used due to cost and complexity.
Elastography (FibroScan):
A non-invasive method that measures liver stiffness to assess scarring.
Liver biopsy:
A small sample of liver tissue is examined to confirm the presence and severity of fatty liver, inflammation, or scarring. This is the most accurate but invasive method.
Can fatty liver disease be reversed?
The big question: If you receive a fatty liver disease diagnosis, can it be reversed?
The good news is that when fatty liver disease is in its early stages, it can often be reversed, or at least significantly improved, with diet and lifestyle changes.
In fact, a 2018 systematic review found that reducing your refined carbohydrates, sugars, and trans fats intake could reduce fat accumulation in the liver.
When can’t fatty liver be reversed? If fatty liver disease progresses to more advanced stages, such as cirrhosis or liver failure, it may no longer be reversible.
The liver tissue becomes severely scarred, and its ability to function is compromised. However, making smart diet and lifestyle changes can prevent further damage and improve your health overall.
Preventing and managing fatty liver disease
1. Maintain a healthy weight
One of the most effective ways to prevent and manage fatty liver disease? It’s maintaining a healthy weight.
Granted this can be easier said than done. The good news is that even a small amount of weight loss can be beneficial.
Studies show that a weight loss of 5-10% can significantly reduce liver fat, decrease inflammation, and even reverse early-stage non-alcoholic fatty liver disease.
Excess weight, particularly visceral fat, contributes to insulin resistance and metabolic dysfunction, both of which play a role in fat accumulation in the liver.
You can lose weight healthily and sustainably with dietary changes, increased physical activity, and other lifestyle tweaks.
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2. Eat a nutrient-dense diet
Want to prevent or manage fatty liver disease and improve your health overall? A diet rich in whole foods, lean proteins, and healthy fats will help.
Research shows that nutrient-dense diets, like the Mediterranean diet, which includes a high intake of fruit, vegetables, whole grains, nuts, and olive oil, can improve liver enzyme levels and reduce fat accumulation.
Meanwhile, reducing your intake of processed foods, refined sugars, and trans fats is equally important.
Research finds that excessive fructose consumption, often found in sugar-sweetened beverages and processed foods, has been linked to increased fat production in the liver, so it’s best to avoid these when you can.
3. Take regular exercise
Moving more plays a key role in improving insulin sensitivity and reducing liver fat. Even a moderate amount of exercise is beneficial.
A study published in 2016 found that moderate-intensity exercise, such as brisk walking for 150 minutes per week, can significantly decrease hepatic fat content.
Resistance training is shown to be helpful, too. Research links it to reductions in liver fat and improved metabolic markers.
4. Limit your alcohol intake
If you have alcoholic fatty liver disease, then eliminating alcohol is essential. And if you have non-alcoholic fatty liver disease, it’s important to lower your consumption, as alcohol can worsen liver damage.
Research finds that even moderate alcohol consumption may speed up the progression of liver fibrosis in people with non-alcoholic fatty liver disease, so it’s best to cut back or consider giving up.
5. Manage blood sugar and cholesterol levels
Elevated blood sugar and cholesterol levels contribute to fatty liver disease by promoting fat accumulation in the liver.
Fortunately, managing blood sugar through fibre intake, controlled carbohydrate consumption, and other dietary changes can mitigate liver fat accumulation.
High triglyceride levels can also contribute to fatty liver disease. However, research shows that a diet rich in monounsaturated fats and fibre can help lower triglycerides and improve liver health.
6. Stay hydrated
One of the simplest things you can do to prevent and manage fatty liver disease is to stay hydrated.
Hydration supports liver function by aiding digestion, flushing out toxins, and promoting efficient metabolism.
If you’re dehydrated, your liver must work harder to remove toxins and metabolise fats.
How you stay hydrated is also important. Research shows that the consumption of sugar-sweetened beverages is strongly associated with non-alcoholic fatty liver disease.
So, consider swapping sugary drinks for water. NHS guidelines recommend that adults consume between 6 to 8 cups (approximately 1.5 to 2 liters) of fluid daily.
Takeaway...
The liver is one of the most important organs in your body. It handles everything from processing nutrients and storing energy to detoxifying harmful substances.
The good news? You can take care of your liver and reduce your risk of fatty liver disease with sustainable lifestyle changes.
Maintaining a healthy weight, eating a nutrient-dense diet, taking regular physical exercise, and staying hydrated will all help prevent fat buildup in the liver.
A healthy future hinges on the habits you put in place now. Ready to create habits that boost your energy, aid weight loss, and protect you against illness?
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