What is fatty liver and why does it occur?
Fatty liver means that fat accumulates in the liver. The condition often develops when the body stores more fat than it uses, but it is also influenced by factors such as genetics, insulin resistance and other metabolic diseases. Fatty liver is particularly common in people with overweight, obesity, type 2 diabetes and metabolic syndrome.
The liver plays a central role in the body's metabolism and helps, among other things, to regulate blood sugar, store energy and break down nutrients. When too much fat is stored in the liver, its function can be affected, and in some people the condition can eventually lead to inflammation and liver damage.
Today, the term MASLD (Metabolic dysfunction-associated steatotic liver disease) is often used for the most common form of fatty liver. The diagnosis describes fatty liver that is linked to metabolic risk factors, such as insulin resistance, overweight and type 2 diabetes.
In some people, fatty liver progresses to MASH (Metabolic dysfunction-associated steatohepatitis). MASH means that the accumulation of fat in the liver has also led to inflammation and liver damage. Over time, the condition can cause scarring of the liver (fibrosis) and, in some cases, develop into liver cirrhosis. It is therefore important to detect and treat fatty liver at an early stage.
Risk factors: Overweight, insulin resistance and type 2 diabetes
Fatty liver is strongly linked to metabolic risk factors such as overweight, obesity, insulin resistance and type 2 diabetes. The risk increases particularly with an increased amount of abdominal fat, as adipose tissue affects the body's metabolism and can contribute to more fat being stored in the liver.
People with type 2 diabetes or insulin resistance have an increased risk of developing fatty liver. Conversely, fatty liver can also contribute to worsening insulin resistance, which means that the conditions often reinforce each other. Fatty liver is therefore now seen as part of a broader spectrum of metabolic diseases rather than an isolated liver condition.
How is fatty liver diagnosed?
Fatty liver often causes no clear symptoms and is therefore usually discovered through blood tests, health examinations or investigations for other diseases. Elevated liver values may raise suspicion of fatty liver, but normal liver values do not rule out the disease.
The diagnosis is often made through an overall assessment that takes into account medical history, risk factors, blood tests and diagnostic imaging. Ultrasound is the most common method for detecting fat in the liver. In some cases, other examinations, such as elastography (FibroScan) or magnetic resonance imaging, may also be used to assess the amount of fat and any scarring in the liver.
If more advanced liver disease is suspected, such as MASH or liver fibrosis, further investigation may be needed. The aim is to assess how far the disease has progressed and whether there are signs of inflammation or liver damage.
Medical weight loss as treatment for fatty liver
The most important treatment for fatty liver is to reduce the amount of fat in the liver through weight loss and healthy lifestyle habits. For people with overweight or obesity, even moderate weight loss can lead to significant improvements in liver health.
A weight loss of around 7 to 10 per cent of body weight can reduce the amount of fat in the liver and improve liver values. With greater weight loss, inflammation and scarring in the liver may also improve in some people.
Treatment often focuses on a combination of nutritious eating habits, regular physical activity and sustainable long-term lifestyle changes. Dietary changes are an important part of treatment and often aim to create a sustainable energy deficit that enables weight loss. It can also be valuable to limit sweetened drinks, ultra-processed foods and other energy-dense products with a high amount of added sugar, as these have been linked to increased fat accumulation in the liver.
At the same time, it is important to treat other risk factors such as type 2 diabetes, high blood pressure and elevated blood lipids, as these conditions often occur together with fatty liver.
For people with obesity, medication for weight loss can be a complement to lifestyle changes. Weight loss with the help of modern obesity medicines has shown positive effects in studies on both liver fat and other metabolic risk factors. Which treatment is appropriate is determined through an individual medical assessment.
When should you seek healthcare?
If you have risk factors such as overweight, obesity, type 2 diabetes or elevated blood lipids, it may be valuable to discuss your liver health with a healthcare provider. Because fatty liver often causes no clear symptoms, the condition is frequently discovered through blood tests or other health examinations.
If you have elevated liver values or have been told that you have fatty liver, a healthcare provider can help with further investigation, follow-up and advice about treatment and lifestyle habits.
Frequently asked questions about fatty liver (FAQ)
Can fatty liver heal completely and disappear with physical activity and lifestyle changes?
Yes, fatty liver can often improve and, in many cases, resolve, particularly if the condition is detected early. Weight loss and healthy lifestyle habits can reduce the amount of fat in the liver and improve liver values. If the disease has progressed to advanced scarring (fibrosis) or liver cirrhosis, the damage may be more difficult to reverse. Early detection and treatment are therefore important.
What symptoms and early signs can fatty liver cause?
Fatty liver often causes no clear symptoms in its early stages and is therefore frequently discovered by chance, for example during blood tests or an ultrasound examination. Some people may experience tiredness or discomfort under the right ribcage, but the symptoms are often non-specific.
If fatty liver progresses to MASH, inflammation and liver damage can develop. In the longer term, this can in some cases lead to scarring of the liver, impaired liver function or liver cirrhosis.
The diagnosis is made through an overall medical assessment using blood tests, risk factors and sometimes diagnostic imaging, such as ultrasound or elastography.
What is the difference between MASLD and MASH?
MASLD (Metabolic dysfunction-associated steatotic liver disease) means that fat has accumulated in the liver and is linked to metabolic risk factors such as overweight, obesity, insulin resistance or type 2 diabetes.
MASH (Metabolic dysfunction-associated steatohepatitis) is a more advanced form of MASLD in which the accumulation of fat has also led to inflammation and liver damage. MASH increases the risk of scarring of the liver (fibrosis), liver cirrhosis and other complications.
Not everyone with MASLD develops MASH, but MASH is considered a more serious stage of the disease.
How much weight do I need to lose for my liver to improve?
A weight loss of around 7 to 10 per cent of body weight can often reduce the amount of fat in the liver and improve liver values. The extent of the effect varies between individuals.
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