Fatty Liver Disease

Fatty liver disease is one of the most common liver conditions in Australia, affecting roughly one in every three adults. In most cases it develops without obvious symptoms, which means many people are unaware they have it until abnormalities appear on a routine blood test or scan. Understanding what the condition involves, what causes it, and how it can be managed is an important first step toward protecting your long-term health.

What is Fatty Liver Disease?

A healthy liver contains very little fat. Fatty liver disease is a condition in which excess fat accumulates within liver cells. When fat accounts for more than five percent of the liver’s total weight, the condition is considered clinically significant. Over time, if left unmanaged, the fat build-up can cause liver inflammation, scarring (known as fibrosis), and in more advanced cases, cirrhosis.

There are two main forms of the condition. Metabolic (dysfunction)-associated fatty liver disease, or MAFLD, is the most prevalent and is closely linked to metabolic risk factors such as excess body weight, type 2 diabetes, and high blood fat levels. It was previously referred to as non-alcoholic fatty liver disease (NAFLD). The second form is alcohol-related fatty liver disease, which develops as a direct result of excessive alcohol consumption.

Understanding MAFLD and MASH

MAFLD exists on a spectrum. At the milder end, fat is present in the liver but there is no significant inflammation or damage. At the more serious end, the accumulated fat triggers an inflammatory response within the liver, a stage known as metabolic steatohepatitis, or MASH.

MAFLD is strongly associated with insulin resistance, a state in which the body’s cells do not respond normally to insulin, the hormone responsible for regulating blood sugar levels. When insulin resistance is present, blood sugar levels may rise above the normal range. Both MAFLD and MASH are more commonly seen in people who are overweight or who have type 2 diabetes, and these individuals often have elevated levels of blood fats such as cholesterol and triglycerides.

MASH is a chronic condition that tends to worsen gradually. The risk of progression is greater in people who also have another liver disease, such as hepatitis B or C, or who drink alcohol to excess. Without appropriate management, MASH can lead to cirrhosis, and in some cases liver cancer.

Symptoms of Fatty Liver Disease

The majority of people with fatty liver disease have no symptoms at all, particularly in the earlier stages. When symptoms do occur, they tend to be mild and non-specific, such as fatigue or a dull discomfort in the upper right area of the abdomen. It is worth noting that fatty liver disease does not cause nausea or food intolerance.

Signs that suggest more advanced liver disease may be present include yellowing of the skin or eyes (jaundice), abdominal swelling, unexplained bruising, dark-coloured urine, black or tarry stools, vomiting of blood, and persistent itching of the skin. If you notice any of these symptoms, it is important to seek medical attention promptly.

Causes and risk factors

Fatty liver disease does not arise from eating fatty foods alone. It typically develops as a result of several contributing factors that act on the body over a prolonged period. The most common risk factors include being overweight or obese, particularly when excess weight is carried around the waist (approximately seven in ten people who are classified as obese have fatty liver disease), having type 2 diabetes or insulin resistance, and having elevated blood fat levels, including high cholesterol or high triglycerides. Drinking too much alcohol is also a significant contributor.

Less frequently, fatty liver disease may be associated with an underactive thyroid (hypothyroidism), polycystic ovary syndrome (PCOS), or certain medications. In rare circumstances, a distinct form known as acute fatty liver of pregnancy can occur during the third trimester or shortly after birth.

Why Fatty Liver Disease needs attention

Beyond the liver itself, fatty liver disease is associated with a higher risk of cardiovascular disease, stroke, and kidney disease. In some people, it will also progress to cirrhosis, which can result in abdominal fluid accumulation, bleeding complications, cognitive changes, and an increased likelihood of liver cancer. Identifying the condition early and taking steps to manage the contributing risk factors is important for reducing these outcomes.

How Fatty Liver Disease is diagnosed

Because fatty liver disease so rarely causes symptoms, it is commonly discovered during investigations undertaken for other reasons. A routine blood test revealing abnormal liver function results will typically prompt further assessment. Your doctor will take a thorough history, conduct a physical examination, and arrange appropriate tests.

Imaging of the liver is usually the next step. An ultrasound is most commonly used, though a CT scan or MRI may also be performed. A FibroScan, which uses a technology similar to ultrasound, can provide a specific measure of both liver fat and the degree of any scarring, though this is not available at every facility.

In some circumstances, a liver biopsy may be recommended. This involves taking a small sample of liver tissue for examination under a microscope, which allows a more precise assessment of the extent of fat accumulation, inflammation, and any scarring present. Your doctor may refer you to a gastroenterologist for further specialist evaluation and management.

Managing Fatty Liver Disease

Currently, no approved medications or surgical procedures are available in Australia specifically for the treatment of MAFLD. The good news, however, is that the condition can respond very well to lifestyle change. In many people, appropriate modifications to diet and physical activity can reduce liver fat, slow the progression of disease, and in some cases reverse liver damage.

If you have been diagnosed with alcohol-related fatty liver disease, ceasing or significantly reducing alcohol consumption is the single most important step to prevent the condition from worsening.

Weight management

For people who are overweight, a reduction of approximately four to ten percent of body weight can slow the progression of MAFLD and may reverse liver damage. A gradual and steady approach is recommended, aiming for a loss of around 0.8 to 1 kg per week. Achieving a waist circumference of less than 80 cm for women and less than 94 cm for men is a useful target.

If you are making genuine efforts with diet and exercise but not losing weight, it is still worthwhile persevering. Improvements in dietary quality and regular physical activity can reduce liver fat even in the absence of weight loss. Your doctor or dietitian can provide personalised guidance, including advice on dietary patterns such as the Mediterranean-style diet or intermittent fasting, which have shown benefits for some people with MAFLD.

Physical activity

Regular exercise directly benefits liver health, independent of its effect on body weight. Aerobic activity of moderate to higher intensity, such as brisk walking, cycling, dancing, or team sports, is recommended on three to five days per week, accumulating a minimum of 150 minutes in total. Resistance-based exercise using weights or bodyweight movements should also be incorporated on two to three days per week, as it plays an important role in maintaining muscle mass, particularly during periods of weight loss. An accredited exercise physiologist can provide an individualised program tailored to your specific circumstances.

Dietary approach

A diet rich in vegetables, wholegrains, fruit, nuts and seeds, legumes, fish and seafood, and extra virgin olive oil is associated with positive outcomes for liver health. Minimising highly processed foods, sugary products, and refined carbohydrates is equally important. Managing diabetes and cholesterol through both dietary means and prescribed medication also reduces the risk of further liver damage.

Alcohol intake should be eliminated or kept to a minimum. Smoking cessation is also recommended, as is avoiding any medications or substances not prescribed by your doctor.

Additional support

Depending on the underlying causes and complexity of your condition, your gastroenterologist or GP may recommend a referral to a dietitian, exercise physiologist, or other specialist to support your management plan. For those whose fatty liver disease is related to alcohol use, referral to appropriate counselling or support services may also be discussed.

Can Fatty Liver Disease be prevented?

The same lifestyle measures used to manage fatty liver disease are also effective in reducing the risk of developing it in the first place. Maintaining a healthy body weight, eating a diet high in vegetables, wholegrains, and healthy fats, being physically active on most days, and keeping alcohol consumption low are the most important protective factors.

When to see a gastroenterologist

If your GP has identified abnormal liver function results or found signs of fatty liver disease on an imaging scan, a referral to a gastroenterologist is appropriate. Specialist review is particularly important if there is concern about the degree of liver inflammation or scarring, if initial management has not produced the expected improvement, or if your clinical picture is complex.

Queensland Gastroenterology provides comprehensive assessment and ongoing management of fatty liver disease and other liver conditions. Our gastroenterologists work closely with patients and their GPs to develop a clear understanding of the condition, identify contributing factors, and establish an appropriate plan for management and monitoring.

If you have received a referral to see one of our doctors, you can request an appointment, or contact our rooms directly on (07) 3321 1500.

This information has been sourced and adapted from education resources developed by GESA (Refer Our Website) and Health Direct Australia (Refer Our Website).