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Fatty liver is now found on roughly one in three routine ultrasounds. Most people are told it is 'nothing to worry about' — which is true only if something is done about it.
What it means
Non-alcoholic fatty liver disease is the accumulation of fat within liver cells in people who do not drink significantly. It is the liver's manifestation of insulin resistance, and it travels with abdominal obesity, type 2 diabetes, high triglycerides and high blood pressure.
In most people it remains simple fat accumulation and causes no harm. In a meaningful minority it progresses to inflammation (steatohepatitis), then fibrosis, then cirrhosis — and non-alcoholic fatty liver disease is now among the leading causes of cirrhosis and liver cancer worldwide.
Why it is usually silent
There are typically no symptoms. It is found incidentally on an ultrasound done for something else, or suspected when liver enzymes are mildly raised on a routine blood test. Some people describe vague fullness or discomfort under the right ribs and fatigue.
Because it causes no symptom, the diagnosis is easy to dismiss — and that dismissal is why some patients present a decade later with cirrhosis.
Assessment worth asking for
- Liver function tests, including ALT and AST
- Fasting blood sugar and HbA1c
- Lipid profile
- Hepatitis B and C screening, to exclude other causes
- Thyroid function
- A fibrosis assessment such as FIB-4 or a fibroscan, to determine whether scarring has begun
- An honest account of alcohol intake — this changes the diagnosis and the management entirely
Worth knowing
The key question is not whether there is fat in the liver but whether there is fibrosis. That distinction determines whether this is a lifestyle matter or a liver disease requiring specialist follow-up.
Treatment: weight loss is the medicine
There is no licensed drug that reverses fatty liver as reliably as weight reduction does. Losing 5% of body weight reduces liver fat; 7% improves inflammation; 10% can reverse early fibrosis. These are achievable numbers — for an 80 kg person, 8 kg.
Practical steps: cut sugary drinks and fruit juice completely, since fructose is metabolised directly into liver fat; reduce refined carbohydrate portions; increase protein and vegetables; walk daily and add resistance training twice weekly; and treat diabetes and lipids properly. Avoid alcohol entirely if fatty liver is present, whatever the cause.
What to avoid
- Unregulated 'liver detox' supplements and herbal preparations — several cause liver injury directly
- Crash dieting, which can worsen liver inflammation
- Unnecessary paracetamol in high doses, and NSAIDs where liver function is impaired
- Assuming that normal liver enzymes mean the liver is fine — fibrosis can progress with normal enzymes
Key takeaways
- Fatty liver is the liver's expression of insulin resistance, not a benign incidental finding.
- The important question is whether fibrosis has developed, not just whether fat is present.
- Losing 7–10% of body weight can reverse inflammation and early scarring.
- Avoid 'liver detox' supplements — several cause genuine liver injury.
A note on medical advice
This article is general health education written and reviewed by the Department of Gastroenterology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
Fatty liverNAFLDLiverMetabolic health
