Fatty liver: symptoms, treatment, causes and whether it can be reversed

The NHS says non-alcoholic fatty liver disease does not usually cause any symptoms, and many people have it without realising. It is usually found when you have tests for another reason.

Some people do have symptoms. The NHS lists feeling very tired, feeling generally unwell, and liver pain or discomfort felt in the tummy under the right side of the ribs.

Liver UK says some people only find out when they are being tested for something else, and that at more advanced stages people may start to notice symptoms.

Liver UK says treatment has two main aims: to stop the condition getting worse so it does not lead to serious problems such as cirrhosis, liver failure or liver cancer, and to help your liver repair as much damage as possible.

For most people the main treatments are keeping a healthy weight or losing weight if needed, eating a healthy, well-balanced diet, and being more physically active and reducing time spent sitting.

The NHS says that apart from healthy lifestyle changes, you will not need other treatment unless your condition has progressed and you have damage to your liver. If you have fibrosis or cirrhosis you will need to see a liver specialist in hospital.

Liver UK says there is no special diet that cures MASLD. Most people benefit from a healthy, well-balanced diet and working towards a healthy weight.

The NHS advises eating a healthy, balanced diet and keeping to no more than 14 units of alcohol a week.

Liver UK suggests asking to be referred to a registered NHS dietitian, who can help you make realistic, long-term changes. It advises small changes you can stick with, and says that if you are at a healthy weight it is important to avoid gaining weight.

Liver UK says to lose weight steadily: aim to lose 2 pounds (1 kg) a week at the most. If you have stage 4 disease (cirrhosis), talk to your doctor before trying to lose weight.

Liver UK says being more physically active is one of the best ways to reduce liver fat. It advises at least 150 minutes of moderate intensity activity every week, which can be broken into 10-minute sessions, plus muscle-strengthening activity twice a week.

Examples it gives are brisk walking, swimming, dancing and cycling, and lifting weights, resistance bands or carrying heavy shopping for strength.

Liver UK says something goes wrong with how the body uses and stores energy, which causes fat to build up inside liver cells. We do not fully understand why it builds up in some people and not others.

The NHS says you are more likely to get it if you are overweight, particularly with a lot of fat around your stomach and waist, do not have a healthy diet or are not very physically active, have type 2 diabetes, polycystic ovary syndrome, high blood pressure or high cholesterol, or are over 50.

Liver UK adds genes, hormones (menopause can increase the risk in women), ethnic background (people of Asian descent may be at higher risk), age and sex (risk is higher in men), and that about 2% of cases are linked to prescribed medicines. It says not to stop any prescribed medicine without speaking to your doctor.

Alcohol-related fatty liver is a separate condition, covered by the NHS under alcohol-related liver disease. The NHS says in its first stage, fat builds up and the liver can usually recover if you stop drinking.

Liver UK says MASLD can be treated and even reversed with changes to your daily life, especially in the early stages when the liver is less damaged, and that diet and physical activity can help repair some damage in more advanced stages.

The NHS says healthy lifestyle changes can reduce the build-up of fat in the liver, help repair damage and stop it getting worse.

The NHS says there are 4 stages and most people only have the first. In order they are fatty liver (steatosis), MASH (inflammation), fibrosis and cirrhosis.

Fibrosis means damage to the liver, though it will usually still be working well. Cirrhosis means severe damage that affects how well the liver works and can cause internal bleeding, liver failure, liver cancer or sepsis.

NICE says MASLD has become the most common chronic liver disease in children and young people in industrialised countries, mainly as a result of obesity. Liver UK has dedicated information for children and families.

The NHS says to see a GP if you think you could have fatty liver disease or have a higher risk of getting it.

Symptoms of advanced liver damage, from the NHS alcohol-related liver disease page, include yellowing of the skin or whites of the eyes (jaundice), swelling of the tummy or legs and confusion. The NHS says to call 999 or go to A&E if you vomit blood, your poo is black and sticky, or you feel suddenly confused, dizzy or have difficulty staying awake.

On the NHS your GP can arrange blood tests and scans, and refer you to a liver specialist if there are signs of fibrosis or cirrhosis. Liver UK says that if you need help with weight, you can ask about a registered NHS dietitian and local weight management programmes.

Private scans and blood panels are available. Share results with your GP so follow-up stays joined up.