Your Guide to Fatty Liver Disease

Many people think of fat as something they can see, like body fat or fat on a piece of meat. But fat can also build up in your liver. Fatty liver disease affects millions of people in the United States, including many in San Antonio and the Rio Grande Valley.

About 25% of people in the U.S. have fatty liver disease. That’s nearly 100 million people, and that number continues to grow.

“Fatty liver disease has become more common both in the United States and around the world over the past few decades,” said Kathy Crow, a physician assistant-certified with University Health Transplant Institute. “In fact, it’s more than 50% more common than it was three decades ago.”

What Is Fatty Liver Disease?

Fatty liver disease happens when too much fat builds up in the liver. A healthy liver contains a small amount of fat. But when more than 5% to 10% of the liver is made up of fat, it’s considered a fatty liver.

There are two types of fatty liver disease:

• Alcoholic fatty liver disease (AFLD) is caused by drinking too much alcohol over time. AFLD is the earliest stage of alcohol-related liver disease.
• Metabolic dysfunction-associated steatotic liver disease (MASLD) is formerly called nonalcoholic fatty liver disease. It is not caused by drinking alcohol. There are two types of MASLD: simple fatty liver and metabolic-dysfunction-associated steatohepatitis, or MASH.

“Sometimes fat builds up in the liver without having much impact on liver health,” Crow said. But in other cases, as with MASH, this buildup can cause inflammation and injury to liver cells. Eventually, this can lead to scarring of the liver and even significant enough damage that a liver transplant is required.

Risk Factors of Fatty Liver Disease

Alcoholic fatty liver disease affects people who drink large amounts of alcohol over a long period. It’s most common in women who drink heavily and are obese.

Anyone can develop metabolic dysfunction-associated steatotic liver disease, but some people are more likely to develop it than others. Risk factors include:

• Being Hispanic
• Having high blood pressure
• Having hepatitis C or certain other infections
• Having metabolic syndrome or another type of metabolic disorder
• Having obesity
• Having prediabetes or Type 2 diabetes
• Rapidly losing weight
• Taking certain medications, such as corticosteroids

High levels of fats in the blood also increase your risk. This includes high cholesterol, high LDL cholesterol or high triglycerides.

Although MASLD is most common in middle-aged and older adults, more children are being diagnosed with it. Today, it is the most common liver disease in children.

Complications of Fatty Liver Disease

Some people with fatty liver disease never develop serious liver problems. But for others, the disease can get worse over time and lead to serious health complications.

These complications can include inflammation, cirrhosis (scarring of the liver) and liver failure. They are more common in people with MASH, the more severe form of MASLD.

MASH causes ongoing inflammation and damage to liver cells. Up to 15 million people in the U.S. may have MASH. Over time, it can lead to hepatocellular carcinoma, which is a type of liver cancer, and is one of the leading reasons people need a liver transplant.

“MASH is the second leading cause of liver transplant in the United States,” Crow said. “Among women, it’s the leading cause.”

How Do I Know If I Have Fatty Liver Disease?

Fatty liver disease can be hard to spot because it often doesn't cause symptoms, especially in its early stages.

When symptoms do occur, they may include:

• An enlarged liver
• Fatigue
• Mood changes
• Pain in the upper right side of the abdomen

MASH and severe alcoholic fatty liver disease can cause more serious symptoms, including:

• Abdominal pain and swelling (ascites)
• Dark urine
• Enlarged blood vessels just beneath the skin’s surface
• Enlarged breasts in men
• Enlarged spleen
• Red palms
• Yellow bumps around the eyelids
• Yellowing of the skin and eyes (jaundice)

If you have symptoms that could be related to your liver, talk to your primary care provider. Finding fatty liver disease early can help prevent it from getting worse or slow its progression.

Your provider may order blood tests to check your liver enzymes. High liver enzyme levels can be a sign of liver inflammation or damage, but they don't always mean you have fatty liver disease.

If your blood test results are abnormal, your provider may recommend additional testing, such as an ultrasound or a liver biopsy. These tests can help confirm whether you have fatty liver disease and show how advanced it is.

Even if you don't need care from a liver specialist, regular follow-up with your primary care provider or a gastroenterologist can help monitor your liver health. Healthy lifestyle changes, including weight loss and avoiding alcohol, can help lower your risk of serious complications.

How Do You Treat Fatty Liver Disease?

If your primary care provider thinks you may have fatty liver disease, they may refer you to a liver specialist, called a hepatologist. Treatment depends on the type of fatty liver disease you have and how advanced it is.

Lifestyle Changes

MASLD is closely linked to obesity, excess body fat and conditions such as Type 2 diabetes. For many people, healthy lifestyle changes are the first step in treatment.

Your provider may recommend losing weight, exercising regularly and eating a healthy, balanced diet. If you have fatty liver disease, your provider will likely recommend avoiding alcohol because it can make liver damage worse.

Eating more foods that support liver health can also help. These include:

• Avocados
• Fish
• Green tea
• Green vegetables, such as broccoli, spinach, kale and Brussels sprouts
• Nuts
• Olive oil
• Soy protein
• Whole grains, including oats, bulgur, quinoa, brown rice and rye

Some of these foods, such as avocados, fish, nuts and olive oil, contain healthy fats. Unlike saturated and trans fats, healthy fats can support your overall health when eaten as part of a balanced diet.

Medications

Your provider may prescribe medications to help manage health conditions that can make fatty liver disease worse. These include high blood pressure, high cholesterol and high triglycerides.

If you have diabetes, your provider may recommend a medication called a GLP-1 receptor agonist. Studies show these medications may reduce liver fat and inflammation while also helping improve heart health.

It's also important to stay up to date on recommended vaccines, including the flu and pneumonia vaccines. Your provider may also recommend the hepatitis A and hepatitis B vaccines because these infections can increase the risk of liver failure in people with fatty liver disease.

Transplantation

MASH can cause severe liver damage and liver failure. When this happens, a liver transplant may be the best treatment option.

University Health performs about 100 transplants annually, including about 35 for patients with fatty liver disease. It is home to the largest living donor liver transplant program in Texas and the third-largest program in the United States by volume.

In a living donor liver transplant, a family member or loved one donates a portion of their liver. Over time, the liver grows back in both the donor and the recipient.

Liver Care at University Health

If you’re experiencing health problems related to your liver, including fatty liver disease, you want the care of a team of experts. That’s what you’ll find at University Health, where our team includes providers such as hepatologists, gastroenterologists and transplant surgeons.

Learn more about our expert liver care.

Our providers have unique training and expertise in diagnosing, treating and managing a full spectrum of liver diseases. They’ll work together to restore and protect your liver health.