Abdominal pain may be caused by a wide range of problems. "Attacks" of pain in the right upper abdomen lasting for several hours may be due to gallstones...

Fatty Liver

Yellow appearance of a liver with excess fat

What is fatty liver?


  • Answer : simply what the name suggests - too much fat in the liver!
  • Some important facts:
    • Fatty liver is the accumulation of fat (mainly as triglycerides) within liver cells.
    • This happens when the fat coming into the liver is more than the fat going out (the liver makes and secretes fat).
    • This condition is becoming more common.
    • It is the commonest cause of abnormal liver enzyme tests (blood tests for the liver). This is because fat in the liver may cause some inflammation.

What causes fatty liver?

  • Excess alcohol intake may be the main underlying cause.
    • How much is too much?
    • Refer also to section on alcohol and liver.
    • One study showed that the risk of moderate alcohol intake (2 standard drinks per day; less than 20g) causing NAFLD is 5-fold for non-obese men, 15-fold for overweight men and 35-fold for obese men.
    • Safe limit may only be 3 standard drinks per week  - better to be nil
  • There are an increasing number of people with fatty liver that is NOT caused by alcohol.
    • This condition has an association with being overweight, having diabetes (or pre-diabetes - also called impaired glucose tolerance -  and having raised cholesterol or raised triglyceride levels in the blood.
  • The underlying problem is considered to be "insulin resistance".
    • This means that the body is not responding normally to the insulin hormone.
    • This problem directly relates to the amount of fat tissue in the body.
    • Fatty tissue is not inert. It secretes a range of hormones that control the body's metabolism.
    • Insulin resistance promotes increased rate of delivery of fat to the liver from the tissues.
    • Insulin resistance (and therefore fatty liver) is primarily determined by body weight and also the level of physical activity.
    • Fatty liver is a marker for significant insulin resistance and is associated with a 2- to 5-fold risk of developing type 2 diabetes


      The main risk to health with fatty liver is not severe liver disease but diabetes, heart disease and stroke - all long term consequences of insulin resistance / metabolic syndrome
  • Fatty liver is more common some ethnic groups.
    • That is, for a given weight there is more fatty liver in some groups.
    • It is more common with Indian and Chinese compared with European groups. It is also more common in Pacific Islanders.
  • About 10% of people with excess fat in the liver will develop inflammatory in the liver.
    • The medical term is called steatohepatitis.
    • This sometimes abbreviated as NASH - non-alcohol steatohepatitis.
    • Another abbreviation is NAFLD (non-alcoholic fatty liver disease).
  • This inflammatory process, if sustained over a long period of time, can lead to significant liver fibrosis and eventually to cirrhosis (severe liver damage).
    • The risk is low (compared to other causes of liver disease).
    • Overall only 2% will progress to cirrhosis.  This is a much smaller risk than for fatty liver caused by alcohol


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