Fatty liver disease

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

You can help to 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 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.

Can I drink alcohol if I have non-alcoholic fatty liver disease?

Answer

If you have mild non-alcoholic liver disease without any inflammation of your liver, you may be able to drink small amounts of alcohol occasionally. Ask your doctor for advice.

Explanation

Drinking alcohol can increase the amount of fat in your liver, and can therefore make existing fatty liver disease worse.

The recommendation for safe drinking is 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. However, if you have non-alcoholic liver disease, it’s probably best to stop drinking altogether, or perhaps just enjoy the occasional drink at a special event or celebration.

What should I eat if I have been diagnosed with non-alcoholic fatty liver disease?

Answer

You can reduce the amount of fat in your liver by eating a healthy diet, which is low in saturated fat.

Explanation

Some of the fat that builds up in your liver comes from the foods that you eat. Therefore, choosing low-fat foods and eating a healthy, balanced diet can help you to stay healthy. A healthy diet combined with an active lifestyle can help you to lose any excess weight, which will also help to reduce the amount of fat in your liver.

A balanced, healthy diet is made up of:

  • fruit and vegetables – ideally 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, you can reduce your weight and the amount of fat in your liver by being more active. You should aim to do some physical activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more.

My liver function tests were ‘abnormal’. What does that mean and should I be worried?

Answer

Abnormal liver function tests aren’t uncommon and don’t always mean you have a serious liver condition. Talk to your doctor for more information.

Explanation

Liver function tests are blood tests. A sample of your blood is taken and sent to a laboratory where a number of different tests are carried out on it. Liver function tests are done to help your doctor see whether your liver is inflamed or damaged, and whether it’s working properly.

When the results are sent back to your doctor, the laboratory will give your results along with a normal or reference value. This shows your doctor whether your test results are within the normal range. If your test is abnormal, it means that your results are either higher or lower than the normal range for the test.

Abnormal liver function tests aren’t uncommon and don’t necessarily mean that you have serious liver problems. Some of the tests are not very specific and an abnormal test can be due to other conditions, not just liver disease.

Liver function tests can be affected if you have had a recent viral infection, or if you have used drugs or have recently had a lot of alcohol to drink. 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 have had an abnormal liver function test, talk to your doctor for more information about what it might mean.