If you’ve recently had an ultrasound that showed fatty liver disease, you’re not alone. It is one of the most common liver conditions in the United States. Melanie Garvin, NP-BC, Gastroenterology, shares answers to patients' most asked questions after receiving this diagnosis.
I don’t drink alcohol. How did this happen?
Many patients are surprised to learn they have fatty liver disease because they rarely drink alcohol or don’t drink at all. While alcohol consumption can cause fat to accumulate in the liver, it isn’t the most common cause. Today, most cases of fatty liver disease are related to metabolic health conditions such as:
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Overweight or obesity
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Prediabetes/insulin resistance
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High cholesterol/triglycerides
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Family history and genetics
Because these metabolic conditions play such an important role, fatty liver disease is now often known as metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD).
Developing fatty liver disease doesn’t necessarily mean you’ve done anything wrong. It often develops as a result of factors that are common and sometimes beyond our control.
How serious is fatty liver disease?
The answer depends on whether liver scarring is present. Many people with fatty liver disease simply have fat stored in the liver and never develop significant liver damage. Others may develop inflammation and scarring over time.
One of the first questions I ask myself when I see a patient with fatty liver disease is not, “How much fat is there?” but rather, “Is there any scarring?” That’s because scarring, also called fibrosis, is the biggest predictor of future liver problems.
To help answer that question, your provider may order blood tests, calculate a fibrosis score, or recommend a FibroScan®. This painless test measures liver stiffness and helps estimate the extent of scarring.
Is this going to turn into cirrhosis?
Not necessarily. This is often the biggest fear patients have after hearing the words “fatty liver disease.” Fortunately, most people with fatty liver disease will never develop cirrhosis. However, some individuals can develop progressive liver scarring over many years.
Risk factors for progression include:
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Obesity
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Metabolic syndrome
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Ongoing liver inflammation
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Significant fibrosis already present
The purpose of early evaluation is to identify patients who may be at higher risk and intervene before advanced liver disease develops.
How much weight do I need to lose?
Patients are often relieved when I tell them they don’t need to lose 50 pounds overnight. Modest weight loss can improve liver health.
Research has shown that:
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Losing about 5% of body weight can reduce the amount of fat in the liver.
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Losing 7% to 10% of body weight may improve liver inflammation and even early scarring.
For example, a person weighing 200 pounds may begin seeing improvement with a weight loss of about 10 pounds. Greater benefits are often seen with a loss of 14 to 20 pounds. The goal isn’t perfection. Sustainable lifestyle changes are far more effective than crash diets or rapid weight-loss plans.
Is fatty liver disease reversible?
One of the remarkable things about the liver is its ability to heal. When fatty liver disease is identified early, reducing liver fat through weight loss, exercise and management of underlying conditions such as diabetes or high cholesterol can significantly improve liver health.
The earlier changes are made, the better the opportunity for the liver to recover.
Final thoughts
A diagnosis of fatty liver disease can feel overwhelming, but it doesn’t mean you’re destined to develop cirrhosis or liver failure. Most importantly, it gives you an opportunity to take action.
By understanding your individual risk, making healthy lifestyle changes and working closely with your healthcare team, you can take important steps toward protecting your liver and your long-term health.
References
National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Nonalcoholic fatty liver disease & NASH. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
Rinella, M. E., et al. (2023). A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology, 78(6), 1966-1986.
Rinella, M. E., et al. (2023). AASLD practice guidance on the clinical assessment and management of NAFLD. Hepatology, 77(5), 1797-1835.
