What is fatty liver?
The liver is a large organ on the right side of the belly that processes food, stores energy and removes toxins. A small amount of fat in the liver is normal. When too much fat builds up, it is called fatty liver, or hepatic steatosis. It is now one of the most common findings on routine ultrasound scans in India.
There are two main types. Metabolic (non-alcoholic) fatty liver is linked to excess weight, belly fat, diabetes and high cholesterol. Alcohol-related fatty liver is caused by drinking alcohol. Both can exist together. In some people, fat causes inflammation, which can slowly lead to scarring (fibrosis), cirrhosis and even liver cancer.
Fatty liver disease: causes and risk factors
Fatty liver is closely tied to insulin resistance, the same problem behind type 2 diabetes. It is common in people with a large waist even when their weight looks normal. It is also seen in children who are overweight. Other causes include certain medicines, rapid weight loss, hepatitis C and some rare conditions. The main risk factors are:
- Being overweight, especially with belly fat
- Type 2 diabetes or prediabetes
- High triglycerides or cholesterol
- High blood pressure
- Regular or heavy alcohol use
- Diet high in sugar, sweets, soft drinks, maida and fried foods
- Little physical activity
Symptoms of fatty liver disease
Most people with fatty liver have no symptoms. It is often found by chance on an ultrasound done for another reason, or when a routine blood test shows raised liver enzymes. Some people have tiredness or a dull ache or heaviness in the upper right side of the belly.
Symptoms of advanced liver damage appear late. They include yellow eyes and skin (jaundice), swelling of the belly or legs, easy bruising, vomiting blood, black stools, confusion and severe weakness. These need urgent medical care. Do not wait for symptoms before taking a fatty liver report seriously.
Tests used
An ultrasound of the abdomen is the most common way fatty liver is found. It is often graded as mild, moderate or severe, but the grade on ultrasound does not tell how much scarring there is. Liver function tests, including ALT, AST and GGT, may be normal or raised.
To check for scarring, your doctor may calculate a score from simple blood tests, or order a FibroScan (liver elastography), a painless scan that measures liver stiffness. You may also be tested for diabetes, cholesterol, thyroid and hepatitis B and C, so that all causes and related problems are treated.
How to reverse fatty liver
The main treatment is lifestyle change, and it works well. Losing weight slowly and steadily reduces liver fat, and larger, sustained weight loss can reduce inflammation and even some scarring. Avoid crash diets and very rapid weight loss, which can harm the liver.
Eat home-cooked meals with plenty of vegetables, dal, pulses, whole grains and millets. Cut down on sugar, sweets, soft drinks, fruit juices, bakery items and fried snacks. Limit white rice and maida. Aim for at least 30 minutes of brisk walking or other activity on most days, plus strength exercises. Avoid alcohol completely if you have fatty liver.
Medicines and safety
There is no single tablet that clears fat from the liver. Doctors focus on treating diabetes, cholesterol and blood pressure, which also protects the liver and heart. Some diabetes and weight-loss medicines have shown benefit for the liver, and in selected people a doctor may prescribe vitamin E or other treatments. These are only on a doctor's prescription.
Be careful with the liver. Do not take herbal or 'liver detox' products without advice, as some can damage the liver. Use paracetamol and other medicines only as the label or your pharmacist advises. Get vaccinated against hepatitis A and B if your doctor recommends it.
Follow-up and special groups
Fatty liver needs regular follow-up, with blood tests and sometimes repeat scans, to see whether it is improving. People with diabetes and fatty liver need closer checks for scarring. Children with fatty liver should be managed with family-wide changes in diet and activity, not strict dieting.
Pregnant women with liver problems need a doctor's review, as some liver conditions are specific to pregnancy. If you have fatty liver on a scan, speak to your doctor about what it means for you, and ask your pharmacist before starting any new medicine or supplement.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Diabetes medicines such as pioglitazone or GLP-1 receptor agonistsMay reduce liver fat and inflammation in people with diabetes and fatty liver.Only on a doctor's prescription; each has its own side effects and is chosen based on your overall health.
- Vitamin ESometimes prescribed for selected people without diabetes who have liver inflammation.Only on a doctor's advice; long-term high-dose use has risks.
- Statins such as atorvastatin or rosuvastatinTreat high cholesterol, which is common with fatty liver, and protect the heart.Generally safe in fatty liver; your doctor will monitor liver tests.
- Ursodeoxycholic acidSometimes prescribed for certain liver and bile conditions.Evidence for simple fatty liver is limited; use only if your doctor advises.
See a doctor urgently if
- Yellow eyes or skin, or very dark urine
- Swelling of the belly or legs
- Vomiting blood or passing black, tarry stools
- Confusion, excessive sleepiness or unusual behaviour
- Severe pain in the upper right belly with fever
- Easy bruising or bleeding from gums or nose
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.