Fatty liver: is it serious, and how is it treated?

Medically reviewed by Dr. Noor Hussam Abu-Farsakh — Gastroenterologist & Hepatologist

Fatty liver is the build-up of fat in liver cells. It is now the most common liver disease, closely linked to excess weight, diabetes and high lipids, and is now called metabolic dysfunction-associated steatotic liver disease (MASLD). Most cases are mild, but some progress to inflammation and fibrosis if untreated.

Who is at risk?

• Excess weight, especially around the waist.
• Type 2 diabetes or insulin resistance.
• High triglycerides or cholesterol.
• High blood pressure.

Symptoms

Usually none — fatty liver is often found by chance on ultrasound or raised liver enzymes. Some people feel tired or a heaviness in the upper right abdomen.

How is it assessed?

The key question is not the fat itself but the degree of fibrosis. This is estimated with simple blood-test scores (such as FIB-4) and, when needed, liver stiffness measurement (FibroScan).

Treatment

Lifestyle change is the cornerstone: losing 7–10% of body weight clearly improves fat and inflammation, and may improve fibrosis. A balanced diet (such as Mediterranean), fewer sugars and sweet drinks, and at least 150 minutes of activity a week are recommended.

Controlling diabetes, lipids and blood pressure is essential, and medication is used in selected cases.

When to see a liver specialist

• Persistently raised liver enzymes.
• Tests suggesting fibrosis.
• Diabetes with fatty liver.
• Yellow eyes, abdominal or leg swelling.

This article is for health education and does not replace medical advice.