There are two main types of fatty liver disease.
- Alcoholic liver disease, which, as the name suggests, is caused by drinking too much alcohol.
- Non-alcoholic fatty liver disease, which is caused by other conditions, such as type 2 diabetes or being overweight.
One in three people are thought to have non-alcoholic fatty liver disease. It affects men and women equally, and most people who get it are between 40 and 60. Yet children and teenagers are developing liver disease more now than ever before.
Fatty liver disease can lead to inflammation in your liver and scarring. This is called alcoholic hepatitis if it’s caused by drinking too much alcohol, and non-alcoholic steatohepatitis (NASH) if it’s not. Both of these can eventually lead to cirrhosis, where your liver becomes permanently scarred and damaged, which prevents it from working properly. For more information about alcohol-induced cirrhosis, see our Related information.
Fatty liver disease often has no symptoms. But you may feel tired a lot, or have some discomfort on the right side of your body, just under your ribs.
Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history. It’s important to be honest about your lifestyle and the amount of alcohol you drink. This will help your GP to make the right diagnosis of the type of fatty liver disease you have.
You’ll need to have a blood test to check how well your liver is working. Blood tests may also find the cause of your symptoms, or rule out other possible causes.
You may also need to have one or more of the following tests.
- An ultrasound, CT scan or MRI scan can all be used to create images of your liver and see if there is any fat in it.
- Fibroscan. This is a test that can measures the stiffness of your liver to see if there is any scarring in it. Like ultrasound, it uses sound waves to build up an image.
- A liver biopsy is a small sample of tissue. Your doctor will insert a very fine, hollow needle into your liver under local anaesthetic to collect the sample. This will be sent to a laboratory for analysis
Your GP may refer you to see a hepatologist, a doctor who specialises in conditions that affect the liver.
There aren’t any specific treatments for fatty liver disease but you can take steps to address anything that may be causing it.
If you have fatty liver disease, it’s essential to stop drinking alcohol. If you don’t, the condition can develop into alcoholic hepatitis and then cirrhosis. If you stop drinking, it’s possible that your liver may completely recover. There may be a local group in your area that can offer you support with stopping drinking. If you can’t find a group, talk to your GP about the support that may be available.
If you have non-alcoholic liver disease, it’s important to make changes to your lifestyle. For example, you will need to lose any excess weight and probably exercise more. This can help to reduce the amount of fat in your liver. It’s also important to get treatment for other conditions, such as diabetes.
If you have fatty liver disease, you’re more at risk of cardiovascular disease. Your doctor will check if anything else puts you at risk and help you take steps to reduce this. They will check your blood pressure and cholesterol levels to see if these are within the normal range. You may be advised to take medicines to control these.
A number of things can cause fatty liver disease but the two main factors are:
- being overweight or obese – this increases your risk of developing diabetes or high cholesterol, both of which can also cause fatty liver disease
- drinking too much alcohol
Other things that can increase your risk of developing fatty liver disease include taking some types of medicines, and losing weight rapidly (including through surgery).
Although rare, it’s also possible to develop fatty liver disease when you’re pregnant, usually in the last three months. It can lead to liver failure if it’s not treated quickly. If you have pain in your tummy, are vomiting and the whites of your eyes and skin look yellow, contact your midwife or GP urgently.
There are several different stages of fatty liver disease. The first stage is where fat builds up in your liver without any inflammation or scarring. For many people with non-alcoholic fatty liver disease, the condition won’t get any worse than this and a serious liver condition won’t develop.
In some people, the build-up of fat causes inflammation and scarring, leading to cirrhosis. Cirrhosis can gradually affect how well your liver works, and it can be life-threatening. Fatty liver disease can also increase your risk of getting liver cancer.
You may be able to prevent fatty liver disease by:
- maintaining a healthy weight for your height
- being active – try to do at least 150 minutes of moderate exercise each week, in bouts of 10 minutes or more
- cutting down on foods that are high in fat
It’s also important not to drink too much alcohol. Men shouldn’t regularly drink more than three or four units a day and women two or three units a day. Although ‘regularly’ means every day or most days, it’s a good idea to have a break so you don’t go over the limits. Aim to have at least two alcohol-free days a week. For more information about sensible drinking, see Related information.
Can I drink alcohol if I have non-alcoholic fatty liver disease?
Alcohol is processed by your liver so if you have liver problems, it can be dangerous to drink. Ask your GP if it’s safe for you to drink alcohol and if so, how much.
Drinking alcohol can increase the amount of fat in your liver so if you have fatty liver disease, it can make it worse. If you have non-alcoholic fatty liver disease, ask your doctor if you can drink alcohol.
It’s difficult for doctors to be precise about how much is safe for individual men and women to drink. Current guidelines recommend men don’t regularly drink more than three or four units a day, and women two or three units a day. Although ‘regularly’ means every day or most days of the week, it’s a good idea to have a break so you don’t go over the limits. Aim to have at least two alcohol-free days a week.
Over a week, you shouldn’t have more than 14 units. But this doesn’t mean you can ‘save up’ for a weekend binge. Read our information to find out more about sensible drinking in general.
My liver function tests were ‘abnormal’. What does that mean and should I be worried?
Abnormal liver function tests aren’t uncommon and don’t always mean you have a serious liver condition.
Liver function tests involve taking a sample of your blood and carrying out a number of different tests on it in a laboratory. Liver function tests can help show whether your liver is inflamed or damaged, and if it’s working properly.
Getting an abnormal liver function test result isn’t uncommon and doesn’t necessarily mean that you have a serious liver problem. Some of the tests aren’t very specific and an abnormal test can be caused by other conditions, not just liver disease. Your doctor will use the results of your blood test alongside other tests, such as an ultrasound, to find out if you have fatty liver disease.
If you’ve had an abnormal liver function test result, talk to your doctor for more information about what it might mean.
What should I eat if I have been diagnosed with non-alcoholic fatty liver disease?
It’s a good idea to reduce the amount of fat in your liver by eating a healthy diet that’s low in saturated fat.
Some of the fat that builds up in your liver can come from the foods you eat. So if you choose low-fat foods and eat a balanced diet, it can help to prevent this. A healthy diet combined with an active lifestyle can help you to lose any excess weight. This will also help to reduce the amount of fat in your liver.
A balanced, healthy diet is made up of:
- fruit and vegetables – at least five portions a day
- starchy foods – for example, wholegrain bread, rice and pasta, and potatoes
- low-fat protein – for example, beans, fish, lean meat, eggs and low-fat dairy foods
- only a small amount of food and drinks that contain a lot of fat and/or sugar
As well as changing some of the foods you eat, try to be more active and do some physical activity every day. Aim to do at least 150 minutes (two and a half hours) of moderate exercise over a week. You can break this down into sessions of 10 minutes or more.
- The British Liver Trust
0800 652 7330
- Fatty liver. Medscape. www.emedicine.medscape.com, published 14 December 2014
- Steatohepatitis and steatosis (fatty liver). PatientPlus. www.patient.co.uk/patientplus, reviewed 2 July 2013
- Hepatic steatosis. BMJ Best Practice. www.bestpractice.bmj.com, published 22 August 2014
- Cirrhosis. BMJ Best Practice. www.bestpractice.bmj.com, published 10 September 2014
- Non-alcohol related fatty liver disease. British Liver Trust. www.britishlivertrust.org.uk, published August 2012
- Mi YQ, Shi QY, Xu L, et al. Controlled attenuation parameter for noninvasive assessment of hepatic steatosis using fibroscan: validation in chronic hepatitis B. Dig Dis Sci 2015; 60(1):243–51. doi:10.1007/s10620-014-3341-x
- Wong GL. Update of liver fibrosis and steatosis with transient elastography (fibroscan). Gastroenterol Rep (Oxf) 2013; 1(1):19–26. doi:10.1093/gastro/got007
- Map of Medicine. Alcohol Dependence, and Liver Disease. International View. London: Map of Medicine; 2014 (Issue 1)
- Find support. British Liver Trust. www.britishlivertrust.org.uk, accessed 2 April 2015
- Lipid modification. National Institute for Health and Care Excellence (NICE), July 2014. www.nice.org.uk
- 2013 clinical practice guide on thrombocytopenia in pregnancy. American Society of Hematology. www.hematology.org, published 2013
- Acute fatty liver of pregnancy. Medscape. www.emedicine.medscape.com, published 15 January 2015
- Nonalcoholic steatohepatitis. National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov, published 28 May 2014
- Cirrhosis. Medscape. www.emedicine.medscape.com, published 10 December 2014
- Start active, stay active: a report on physical activity for health from the four Home Countries’ Chief Medical Officers. Department of Health. www.gov.uk, published 2011
- Reducing harmful drinking. Department of Health. www.gov.uk, published 25 March 2013
- Alcohol – problem drinking. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2011
- Liver function tests: the test sample. The Association for Clinical Biochemistry and Laboratory Medicine. www.labtestsonline.org.uk, published 5 October 2012
- Liver function tests: the test. The Association for Clinical Biochemistry and Laboratory Medicine. www.labtestsonline.org.uk, published 5 October 2012
- The British Liver Trust
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Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, April 2015.
This information was updated in January 2016 following revisions to the Department of Health’s guidelines for alcohol consumption.
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