Fatty liver disease is a condition in which fat accumulates in liver cells. The diagnosis often comes as a surprise: a person feels fine, yet an ultrasound describes "diffuse changes" and "increased echogenicity." Below is what this means and how serious it is.
What fatty liver disease is and how it differs from steatosis
Liver steatosis (fatty liver disease, fatty infiltration, liver obesity, "fatty liver") is the most common hepatosis, in which fat accumulates in liver cells. A small amount is normal; the problem is an excess. The terms "fatty liver disease," "steatosis," and "fatty degeneration of the liver" describe the same process.
There are two main types of steatotic liver disease: metabolically associated (MASLD, formerly non-alcoholic fatty liver disease) and alcohol-associated (ALD). Separately, simple steatosis — fat without inflammation — and steatohepatitis (MASH, formerly NASH), when inflammation and cell damage are added, are distinguished.
Why the liver accumulates fat: causes and risk factors
Fat accumulation can be the liver's reaction to toxic effects and a consequence of metabolic disorders. The risk is higher in people:
- with excess body weight, especially with fat in the abdomen and waist area;
- with type 2 diabetes or prediabetes, high cholesterol and triglycerides;
- with elevated blood pressure;
- over 50 years of age;
- taking corticosteroids and certain antitumor drugs, with polycystic ovary syndrome.
Other causes include an unbalanced diet (overeating, fasting, protein deficiency), digestive system diseases with impaired absorption, rapid weight loss, hepatitis C, Cushing's syndrome, myxedema. Steatosis is detected in approximately a quarter of the population of developed countries.
How fatty liver disease manifests
Most people have no symptoms, and steatosis is found incidentally during an examination for another reason. Fatigue, general malaise, heaviness and discomfort in the upper right abdomen under the ribs, and sometimes nausea are possible. The course is often stable, and changes can be reversible with weight loss.
How steatosis is detected: ultrasound, tests and other methods
The reason is usually abnormal liver tests taken for another cause. The doctor clarifies complaints, measures height, weight and waist circumference, examines the skin and eyes (jaundice), and asks about alcohol and medications — this helps rule out other causes.
Then — blood tests, including liver tests and a complete blood count; ultrasound of the abdominal organs (enlarged liver, diffuse increased echogenicity); transient elastography with accuracy above 95% in people without obesity; CT and MRI, where on CT the parenchyma density is below 55 HU; in some cases — a liver biopsy.
Why fatty liver disease is dangerous and what complications occur
There are four stages: 1 — steatosis without damage; 2 — MASH, inflammation without serious damage, but with a risk of worsening; 3 — fibrosis (damage is present, the liver usually functions); 4 — cirrhosis with severe impairment of organ function. Most people remain at the first stage. With steatohepatitis, fibrosis develops in 30–40% of patients, cirrhosis — in approximately 10%; cirrhosis threatens internal bleeding, liver failure, liver cancer, sepsis. Steatosis is also associated with the risk of cardiovascular diseases, chronic kidney disease, hypertension, type 2 diabetes.
When to see a doctor
It makes sense to see a doctor if fatty liver disease is suspected and if risk factors are present. With a diagnosis without liver damage, follow-up examinations are carried out at least once a year, examinations — every 2–3 years; with fibrosis and cirrhosis, a specialist monitors in a hospital setting.
Steatosis itself is not a reason to call an ambulance; 103 or 112 — if signs of internal bleeding or liver failure appear against the background of cirrhosis.
The material is for reference and does not replace a doctor's consultation: the conclusion is made by a specialist based on the results of the examination and tests.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer