What is Fatty Liver Disease

Fatty liver disease occurs when excess fat accumulates in liver cells. In some patients the cause is excess alcohol consumption.  Other patients are more genetically prone to storing fat in the liver, especially when they have “metabolic syndrome”, the umbrella term encompassing diabetes, high cholesterol, high blood pressure, and obesity.  The latter is termed metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as known as nonalcoholic fatty liver disease (NAFLD).  The fat in the liver can cause inflammation, which is termed metabolic dysfunction-associated steatohepatitis (MASH), formerly called nonalcoholic steatohepatitis (NASH).  In serious cases the inflammation can progress to fibrosis (scarring), cirrhosis, and liver failure.

Risk Factors

• Obesity
• Type 2 diabetes or insulin resistance
• High cholesterol or high triglycerides
• High blood pressure
• Heavy alcohol intake (for alcoholic steatohepatitis)

Symptoms

• Many people with fatty liver disease have no symptoms and are diagnosed by abnormal liver tests or imaging.
• When symptoms occur, they may include fatigue and vague right‑upper‑quadrant discomfort.
• In advanced MASH, signs of cirrhosis such as jaundice, ascites, swelling, and confusion may develop.

Diagnosis

• Blood tests can’t confirm MASLD, but can rule out other causes of liver disease including viral infections, autoimmune disorders, or genetic conditions.
• Imaging studies such as ultrasound, CT scan, or MRI can qualitatively visualize liver fat and sometimes cirrhosis.
• Non‑invasive fibrosis assessments such as elastography to evaluate degree of liver scarring.
• Liver biopsy may be performed in select cases

Management

• Lifestyle modifications: Weight loss through diet and exercise is an effective treatment. A 10% reduction in body weight can significantly improve liver inflammation and fibrosis.
• Medications: several medicines are now FDA approved to treat MASH including Wegovy (semaglutide) and Rezdiffra (resmetirom), specifically in patients with an intermediate amount of liver scarring (F2 or F3 fibrosis)
• Controlling metabolic risk factors: Managing diabetes, hypertension, and dyslipidemia is critical.
• Avoiding or limiting alcohol: Essential for alcoholic fatty liver disease and recommended in MASLD/MASH.
• Monitoring: Regular follow‑up with liver tests and imaging to detect progression. Patients with advanced fibrosis or cirrhosis may need surveillance for liver cancer.

Our hepatology team offers comprehensive evaluation and management of fatty liver disease, including coordination with nutrition and weight‑loss programs.