What is fatty liver?

Fatty liver is not a liver disease as such. It simply means there is more fat in the liver than normal. A person with a fatty liver is not necessarily ill.

What causes fatty liver?

Fatty liver can be caused by certain chemical compounds and by nutritional and endocrine disorders. Alcohol is by far the most common drug cause.

Nutritional causes of fatty liver are starvation, obesity, protein malnutrition and intestinal bypass operations for obesity. The endocrine disorder diabetes mellitus often leads to fatty liver. These causes of fatty liver are called non-alcoholic fatty liver disease or NAFLD. In all of these conditions the fatty deposits are occasionally accompanied by some inflammatory changes and scarring of the liver.  Doctors call this condition non-alcoholic steatohepatitis or NASH.

Fatty liver of pregnancy is a serious condition occurring near term. Premature termination of pregnancy may be necessary. Delivery of the baby by Caesarean section may be a life-saving measure.

What are the symptoms?

Uncomplicated fatty liver does not usually produce symptoms because fat accumulates slowly. The liver may be enlarged on physical examination.

In fatty liver of pregnancy there may be nausea, vomiting, abdominal pain and jaundice.

How does fat get into the liver?

Fat enters the liver from the intestines and from the tissues. Under normal conditions, fat from the diet is metabolised by the liver and other tissues. If the amount exceeds what is required by the body it is stored. In obesity some of the fat accumulates in the liver.

Can fatty liver lead to other liver disease?

Fatty liver in people who drink too much alcohol is sometimes followed by more serious liver damage in the form of alcoholic hepatitis. Serious liver damage is less common in diabetes and obese people who don’t drink but if the fat has progressed to NASH then further progression to scarring and even cirrhosis can occur.

How is fatty liver treated?

Treatment of fatty liver is related to the cause. Underlying conditions such as diabetes and elevated lipids require treatment. Fat is decreased by removal of any drugs or other chemical compounds thought to be responsible. In people with metabolic syndrome as the underlying cause a weight reduction and regular exercise program is recommended.

How can I avoid fatty liver?

Do not drink to excess: alcohol can decrease the rate of metabolism and secretion of fat, leading to fatty liver. Overweight patients may have fatty liver, and are also at risk for several more serious conditions such as high blood pressure, stroke, diabetes and heart disease.

It is a good idea to watch your diet: starvation, excess dieting and protein malnutrition can also result in fatty liver.

For further information see the Gastroenterological Society of Australia website.