Fatty liver is most often linked to unhealthy lifestyle habits, such as eating a diet high in fat and carbohydrates, being physically inactive, and drinking too much alcohol. However, fatty liver can also develop due to certain medications, diabetes, hepatitis B or C, malnutrition, and Wilson’s disease.
Also known as hepatic steatosis, fatty liver usually does not cause symptoms and is often found during routine medical exams. As the condition progresses, however, symptoms may appear, including loss of appetite, abdominal pain, bloating, yellowing of the skin and eyes, and pale stools. Read more about the symptoms of fatty liver and complete our online symptoms quiz.
When symptoms that may suggest fatty liver are present, it is important to see a hepatologist or primary care doctor for proper diagnosis and treatment. In most cases, treatment involves adopting healthier eating and lifestyle habits.
Main causes
The main causes of a fatty liver are:
1. Obesity, diabetes, and insulin resistance
Obesity, type 2 diabetes, and insulin resistance are the conditions most often associated with fatty liver. In these cases, the body has trouble balancing the production and use of triglycerides, which leads to excess fat being stored in the liver.
What to do: Follow medical guidance to help lower blood glucose levels. This typically includes eating a balanced diet and exercising regularly. These changes support weight loss, fat burning, and better blood sugar control.
2. High cholesterol or triglycerides
High cholesterol is another common cause of fatty liver, especially when triglyceride levels are elevated and HDL (good cholesterol) levels are low.
What to do: Limit foods high in fat and focus on fiber-rich foods, fruits, and vegetables. This not only helps reduce fat buildup in the liver but also lowers the risk of heart disease. Read more about the low-cholesterol diet your doctor can recommend.
3. Diet high in fat and sugar
A poor diet and lack of physical activity can play a big role in what causes fatty liver. Eating foods high in sugar and fat, with little fiber, combined with a sedentary lifestyle, leads to weight gain and worsens hepatic steatosis.
What to do: Improve your diet by reducing processed foods high in sugar and fat, while choosing more fiber, fruits, and vegetables. Regular exercise also helps the body use stored fat and blood sugar for energy, reducing fat buildup in the liver.
4. Excessive alcohol consumption
Heavy alcohol intake is another cause of fatty liver. For women, this means more than 20 g of alcohol per day, and for men, more than 30 g per day, which is about 2 to 3 drinks.
What to do: Cut back on alcohol to reduce liver inflammation and fat accumulation, which can improve symptoms and overall liver health.
5. Hepatitis B or C
Chronic hepatitis B or C increases the risk of fatty liver and other liver conditions. Damage caused by these infections makes it harder for the liver to work properly, which allows fat to build up.
What to do: Follow the treatment recommended by your doctor. This may include medication, rest, hydration, limiting alcohol, and eating a light, healthy diet.
6. Use of medications
Certain medications, such as amiodarone, corticosteroids, estrogens, and tamoxifen, can contribute to fatty liver. These drugs may cause liver damage, making fat buildup more likely.
What to do: The doctor who prescribed the medication should evaluate whether it can be reduced, discontinued, or replaced.
7. Wilson’s disease
Wilson’s disease is a rare condition that usually appears in childhood. It happens when the body cannot properly process copper, leading to copper buildup in the liver. This damages liver cells and makes it easier for fat to accumulate.
What to do: A doctor should check copper levels in the blood and prescribe treatment, which often includes medications that bind to copper and help eliminate it through the intestines and kidneys. It is also important to limit foods high in copper, such as dried fruits, mushrooms, and nuts.
8. Malnutrition
Malnutrition reduces the body’s lipoproteins, which are needed to carry fat out of the liver. Without enough lipoproteins, triglycerides build up in the liver, leading to fatty liver.
What to do: A nutritionist should guide treatment, which involves gradually increasing daily calorie intake. In some cases, dietary supplements may also be recommended.
How to confirm
Fatty liver often has no symptoms and is usually discovered during a routine abdominal ultrasound. Once suspected, the diagnosis may be confirmed with blood tests that check liver enzymes (AST/TGO and ALT/TGP), bilirubin, cholesterol, and gamma-GT.
In more advanced cases, when fatty liver is not diagnosed or treated early, symptoms such as indigestion, constant fatigue, loss of appetite, and abdominal bloating may appear.
Complications of excess liver fat
The complications of fatty liver depend on lifestyle and other health conditions, such as diabetes, obesity, or immune disorders. In most cases, the liver becomes progressively inflamed, which can eventually lead to serious conditions like cirrhosis.
To lower the risk of complications, it is recommended to eat a diet rich in fruits and vegetables while avoiding foods high in fat and sugar. Regular exercise of at least 30 minutes a day is also important for prevention.