Fatty liver disease

Published by Bupa’s Health Information Team, July 2011.

This factsheet is for people who have fatty liver disease or who would like more information about it.

Fatty liver disease is a term for conditions where fat builds up in the liver. It can be caused by drinking too much alcohol, or it may be unrelated to alcohol, most often a result of being overweight.

About fatty liver disease

In a healthy liver there should be little or no fat. However, sometimes fat molecules, called triglycerides, begin to collect and build up in your liver cells. For most people who have small amounts of fat in their liver it usually causes no problems. When too much fat builds up, this is called fatty liver.

Fatty liver disease is one of the most common types of liver disease and can sometimes lead to serious health problems. Around one in three people are thought to have non-alcoholic 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 as a result of being overweight.

Both types of fatty liver disease can lead to an inflamed liver. This is called alcoholic hepatitis in people who drink too much alcohol, and non-alcoholic steatohepatitis in people who have fatty liver for other reasons. Both of these conditions can eventually lead to cirrhosis, which can be life-threatening.

Symptoms of fatty liver disease

Fatty liver disease often has no symptoms, particularly when it is mild. However, you may feel tired, lose your appetite 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.

As fatty liver disease gets worse and your liver becomes inflamed or scarred, you may notice other symptoms such as:

• swollen abdomen (tummy)
• itchy skin
• being sick and bringing up blood
• dark, black faeces
  
• bruising easily
• confusion or poor memory
• yellow skin and eyes (jaundice)

See your GP as soon as you can if you develop any of these symptoms.

Complications of fatty liver disease

Around one in 10 people who develop an inflamed liver as a result of fatty liver disease will go on to develop cirrhosis in the future. Cirrhosis can be life-threatening as it can lead to liver cancer and liver failure.

If you develop cirrhosis, then 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 causes of fatty liver disease. The main ones are listed below. 

• Drinking too much alcohol. Fatty liver can develop over a long period of time.
• Being overweight or obese. Most people who have fatty liver disease are overweight or obese and, as such, are more likely to develop conditions such as diabetes or high cholesterol, both known causes of fatty liver disease.
• Medicines. High doses of some medicines may lead to fatty liver disease. These include tamoxifen, which is used to treat breast cancer, amiodarone, which is used to treat an irregular heartbeat and premarin and Ortho-est, which are used as hormone replacement therapy (HRT).
• Rapid weight loss, for example after gastric bypass surgery.

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 skin and eyes, you should see your GP straight away.

Diagnosis of fatty liver disease

Fatty liver disease can sometimes be difficult to diagnose, because you may not have any symptoms and there is no single test that can be used to diagnose it.

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 to make the right diagnosis.

Your GP may ask you to take a blood test to check how well your liver is working. You may also have blood tests to check your iron, glucose, cholesterol and triglycerides as well as other levels.

You may be referred to a hepatologist, a doctor who specialises in conditions affecting the liver. He or she may carry out tests listed below.

• Ultrasound or scan. An ultrasound, CT (computed tomography) or MRI (magnetic resonance imaging) scan can all be used to create images of your liver. These images will show any fat in your liver.
• Liver biopsy. This is the only way to confirm a diagnosis of fatty liver disease. A biopsy is a small sample of tissue. It’s taken using a very fine hollow needle that is inserted into your liver to take a small sample of cells. The sample is then sent to the laboratory for analysis.

Treatment of fatty liver disease

If you have alcoholic liver disease, the best way to treat it is to stop drinking alcohol. If you don’t, fatty liver disease may develop into hepatitis and then cirrhosis in the future. By stopping 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 – do at least 150 minutes of moderate exercise over a week in bouts of 10 minutes or more
• eating healthy foods that are low in saturated fat

You can prevent alcoholic liver disease by following the recommendations for safe drinking. This means drinking no more than three to four units of alcohol a day if you’re a man, and no more than two to three units a day if you’re a woman. A unit is a standard measure of spirit, half a 175ml glass of wine or a third of a pint of average strength beer, lager or cider.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.