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Fatty liver disease

Key points

  • Fatty liver disease is a term for conditions where fat builds up in the cells of your liver.
  • There are two main types of fatty liver disease – alcoholic and non-alcoholic.
  • If you have alcoholic liver disease, it’s essential that you stop drinking alcohol.
  • If you have non-alcoholic liver disease, being more active and losing excess weight may help to reduce the amount of fat in your liver.

Couple sitting on a log

Fatty liver disease is a term for conditions where fat builds up in the cells of your liver. It can be caused by drinking too much alcohol or it may be unrelated to alcohol. Non-alcoholic fatty liver disease is most often a result of being overweight, and is particularly common in men and people with diabetes. Fatty liver disease can sometimes lead to serious liver problems, such as liver cancer and cirrhosis.

About fatty liver disease

If your liver is healthy, there should be little or no fat in it. However, sometimes, fat molecules called triglycerides begin to collect in your liver cells. Small amounts of fat in your liver usually cause no problems. However, when too much fat builds up, this is called fatty liver disease.
There are two main types of fatty liver disease.

  • Alcoholic liver disease, which is caused by drinking too much alcohol.
  • Non-alcoholic fatty liver disease, which is caused by other conditions, such as diabetes or being overweight.

Fatty liver disease is becoming one of the most common types of liver disease and can sometimes lead to serious health problems. It’s now as common as alcohol as a cause of liver cirrhosis. Around one in three people are thought to have some degree of non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is more common in men than in women, and is more likely to be diagnosed in people with diabetes and those over 50.

Fatty liver disease can lead to an inflamed 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 related to alcohol. Both of these conditions can eventually lead to cirrhosis, which can be life-threatening. Fatty liver disease can also lead to liver cancer.

Symptoms of fatty liver disease

Fatty liver disease often has no symptoms, particularly when it’s mild. However, you may feel tired, or have pain and discomfort where your liver is – on the right side of your body just under your ribs. This pain is caused by a growing amount of fat inside your liver, which makes it expand, stretching the sensitive membrane that covers your liver.

As fatty liver disease progresses, your liver may become scarred and develop cirrhosis. If you develop cirrhosis, you may notice other symptoms such as:

  • a swollen abdomen (tummy)
  • itchy skin
  • vomiting and bringing up or passing blood
  • bruising easily
  • confusion or poor memory
  • weakness and muscle wasting
  • yellow whites of your eyes and skin (jaundice)

If you develop any of these symptoms, contact your GP straight away.

Complications of fatty liver disease

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, the condition won’t get any worse than this and a serious liver condition won’t develop.

However, for some people, the build-up of fat causes inflammation. Around one in 20 people who develop an inflamed liver as a result of fatty liver disease will go on to develop serious liver problems, such as cirrhosis, liver cancer or liver failure. All of these conditions are life-threatening.

If you develop cirrhosis, even with treatment, your liver is unlikely to return to normal. However, treatment can prevent the condition from getting worse.

Causes of fatty liver disease

There are a number of things that can cause fatty liver disease. The two main ones are:

  • drinking too much alcohol
  • being overweight or obese – this makes it more likely that you will develop conditions such as diabetes or high cholesterol, both of which can also cause fatty liver disease

There are other things that can cause fatty liver disease, including some medicines and rapid weight loss, but these are less common.

Acute fatty liver disease is a very rare complication that can develop during the last three months of pregnancy. It can lead to liver failure if it’s not treated quickly. If you’re pregnant and develop symptoms such as abdominal pain, being sick and yellow whites of your eyes and skin, you should contact your GP straight away.

Diagnosis of fatty liver disease

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. It’s important to be honest about your lifestyle and the amount of alcohol you drink, as this will help your GP make the right diagnosis. Fatty liver disease can sometimes be difficult to diagnose because you may not have any symptoms.

Your GP may ask you to have a blood test to check how well your liver is working. You may have other blood tests to find the cause of your symptoms or to rule out other possible causes.

You may be referred to a hepatologist, a doctor who specialises in conditions affecting your liver. There is no single test that can be used to diagnose fatty liver disease, but he or she may carry out some of the tests listed below.

  • Ultrasound or scan. An ultrasound, CT scan or MRI scan can all be used to create images of your liver. These images will show any fat in your liver.
  • Fibroscan. This is similar to an ultrasound scan – it can help to show any scarring of your liver.
  • Liver biopsy. This is the only way to confirm how much damage there is to your liver. A biopsy is a small sample of tissue. It’s taken using a very fine hollow needle that is inserted into your liver under local anaesthetic. The sample is then sent to a laboratory for analysis.

Treatment of fatty liver disease

If you have alcoholic liver disease, it’s essential that you stop drinking alcohol. If you don’t stop drinking alcohol, fatty liver disease can develop into alcoholic hepatitis and then cirrhosis in the future. If you stop drinking, it’s likely that your liver will recover from fatty liver disease and hepatitis. To make sure you get the right support to help you to stop drinking, talk to your GP.

If you have non-alcoholic liver disease, there is no specific treatment for it. However, making changes to your lifestyle can help to reduce the amount of fat in your liver. Losing excess weight, increasing the amount of activity you do and treating other conditions, such as diabetes and high cholesterol, can all help to reduce the amount of fat in your liver.

Preventing non-alcoholic fatty liver disease

You may be able to prevent non-alcoholic 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
  • eating healthy foods that are low in saturated fat

It’s not possible to be precise about how much is safe for individual men and women to drink. Current guidelines, however, recommend not regularly drinking more than three or four units a day for men, and two or three units a day for women. Although ‘Regularly’ means every day or most days of the week, it’s a good idea to have at least two alcohol-free days a week so you don’t go over the limits. So over a week, men shouldn’t have more than 21 units and women shouldn’t have more than 14 units. 

A unit of alcohol varies, depending on the strength of what you’re drinking. However, one unit is about 25ml of spirit, half a 175ml glass of wine or half a pint of average strength beer, lager or cider.

Produced by Alice Rossiter, Bupa Health Information Team, April 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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