Fatty Liver: Causes, Symptoms and Diagnosis

Health and Nutrition


Fatty liver is also called a non-alcoholic fatty liver (NAFL) in which there is an accumulation of fat in the liver. This does not cause any inflammation or damage to any cells of the liver or lead to any complications (1, 2).

Ideally, a healthy liver contains very little fat. But when there is a build-up of fat in the liver it may not cause problems in the early stages but it may lead to issues later. Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases affecting people in developed countries because of the rising number of people who are obese (3).


Stages of non-alcoholic fatty liver disease (NAFLD) (2)

  1. A simple fatty liver which is also called steatosis is an accumulation of fat in the liver. Most of the time it is not even diagnosed as it does not cause any harm. It only comes to light when tests are conducted for some other problem.
  2. Non-alcoholic fatty liver steatohepatitis (NASH) is the next stage where the liver starts becoming inflamed.
  3. Fibrosis occurs when there is inflammation in the liver over a period of time. Scar tissue develops around the liver and surrounding blood vessels but the liver still functions normally.
  4. Cirrhosis occurs when the liver is inflamed for a long time and permanent damage may occur to the liver because liver becomes scarred and lumpy.

Most people with NAFLD have simple fatty liver. A few of them about 20 % of NAFLD have non-alcoholic steatohepatitis (NASH) (1).



According to a clinical update (3) it was observed that insulin resistance which is associated with metabolic syndrome acts as a trigger for NAFLD. The other factors which precipitate NAFLD along with insulin resistance being adverse genetic, humoral, hormonal and lifestyle factors.

There are certain risk factors which if present may lead to fatty liver (1, 2)

  • Being obese or overweight
  • Having abdominal obesity
  • Being diabetic, having insulin resistance
  • Having high cholesterol and triglyceride levels
  • Being hypertensive that is high blood pressure
  • Smoking
  • Being above the age of 50

NAFLD may be seen even in people without these risk factors and it is not associated with drinking excess alcohol.



The are no symptoms for fatty liver in the early stages. And generally, a person comes to know that he/she has fatty liver when it is discovered while conducting tests for some other reasons.

As the disease progresses symptoms observed are (2)

  • a dull pain on the right side below the ribs
  • weakness
  • weight loss
  • fatigue

If the condition worsens to cirrhosis other severe symptoms set in.



At regular health check-up, a doctor during the physical examination may look for enlarged liver, insulin resistance symptoms such as pigmentation patches or signs of cirrhosis such as yellow tint in eyes and skin (2).

NAFLD may be diagnosed by doing a liver function test. It is a blood test and if the results of this test are abnormal and other conditions such as hepatitis are ruled out then an ultrasound also may be done and the diagnosis of NAFLD is confirmed.

NAFLD is diagnosed when ≥ 5% of the hepatocytes show steatosis in the absence of reasons for secondary steatosis like excessive alcohol consumption (> 20 ml/day in females and 30 ml/day in males) or chronic liver conditions associated with steatosis such as viral or metabolic or other disorders (3).

Other tests may be conducted to see at what stage NAFLD is and suitable treatment is given. The treatment is usually focussed on how to manage the condition.


Final word

There is no particular medicine for NAFLD but the condition can be managed by taking measures such as reducing weight if obese, managing insulin resistance with proper medication etc.  The basis of treatment of NAFLD is serious lifestyle modification and treating the risk factors.



  1. National Institute of Diabetes and Digestive and Kidney Diseases (2016). Definition & Facts of NAFLD & NASH


  1. National Health Service (2018). Non-alcoholic fatty liver disease (NAFLD).


  1. Pappachan, J. M., Babu, S., Krishnan, B. and Ravindran, N. C. (2017) Non-alcoholic Fatty Liver Disease: A Clinical Update, Journal of clinical and translational hepatology. Vol. 5(4).


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