Fatty Liver Disease

What is fatty liver disease?

Fatty liver disease refers to a condition where excess fat accumulates in the liver. While a small amount of fat in the liver is normal, too much can lead to inflammation, scarring (fibrosis), and liver damage over time. In severe cases, it may progress to cirrhosis or even liver cancer. It often goes unnoticed as in the early stages of the disease it does not cause symptoms

What are the stages of fatty liver disease?

Fatty liver disease can progress through several stages:

  1. Simple fatty liver (steatosis)

    • Fat accumulates in liver cells without inflammation or damage. When fat makes up more than 5 to 10% of the total weight of the liver, it’s called fatty liver

  2. Liver inflammation (steatohepatitis)

    • Fat accumulation triggers liver inflammation and injury.

  3. Fibrosis

    • Chronic inflammation leads to scar tissue formation, especially around liver cells and blood vessels.

  4. Cirrhosis

    • Extensive scarring (termed cirrhosis) disrupting liver structure and function. This can result in liver failure or liver cancer.

What are the main causes of fatty liver disease in Australia?

The most common causes in Australia include:

1. Metabolic Associated Fatty Liver Disease (MAFLD)

Previously called non-alcoholic fatty liver disease (NAFLD), MAFLD is linked to:

  • Excess weight i.e. overweight or obesity

  • A large waist size

  • Type 2 diabetes or insulin resistance

  • High blood pressure

  • Elevated cholesterol or triglycerides

This is the most common cause of fatty liver disease in Australia.

  • Approximately 1 in 3 Australian adults are estimated to have fatty liver on imaging.

  • MAFLD accounts for up to 40–50% of all cases of chronic liver disease in Australia.

  • It is the fastest-growing cause of liver-related morbidity, surpassing hepatitis B, hepatitis C, and alcohol-related liver disease in prevalence.

  • With rising rates of obesity and type 2 diabetes, MAFLD is projected to become the leading cause of liver transplantation in the next decade.

2. Alcohol-related fatty liver disease

Regular excessive alcohol intake can lead to liver fat buildup, inflammation, and eventually cirrhosis.

3. Mixed (combined) causes

Many people have both metabolic risk factors and alcohol use, which can accelerate progression and worsen liver damage.

What are the symptoms?

Most people with early-stage fatty liver disease have no symptoms. People are usually diagnosed when they have a blood test (to assess liver function) or ultrasound for something else.

Advanced liver disease may present with signs of liver failure, such as jaundice (yellow skin and eyes, dark urine or itchy skin), ascites (accumulation of fluid in the abdomen), vomiting blood, black poos, confusion or bruising easily.

How is fatty liver disease diagnosed?

Fatty liver disease is often suspected based on abnormal liver tests or imaging, even in people without symptoms. A thorough assessment is needed to determine the cause, extent of liver damage, and appropriate treatment.

Diagnosis may involve:

  • Blood tests:

    • Liver function tests (LFTs) – to assess liver enzyme levels

    • Full blood count (FBC) – particularly platelet count, which may be reduced in advanced liver disease

    • Metabolic health screening – including cholesterol, triglycerides, blood glucose levels and HbA1c

    • Tests for other causes of liver disease – including hepatitis B and C, and iron studies (for iron overload)

  • FIB-4 score:

    • A non-invasive tool that estimates liver fibrosis using age, liver enzyme levels (ALT and AST), and platelet count. It helps identify those at risk of advanced liver disease.

  • FibroScan (transient elastography) or liver elastography:

    • These tests use sound wave technology to measure liver stiffness, which reflects the amount of scarring (fibrosis). It is a quick, painless, and reliable method to monitor liver health.

  • Liver biopsy:

    • Occasionally needed when there is uncertainty about the diagnosis or to accurately assess the degree of liver inflammation and fibrosis, especially in complex cases.

How is fatty liver disease treated?

There is no specific medication for fatty liver disease itself, at present treatment focuses on reversing risk factors.

For MAFLD:

  • Monitoring and treatment of cirrhosis (if present)

  • Weight loss – 5-10% weight loss can significantly improve liver health

  • Healthy diet – improved diet quality. Eat a balance healthy diet rich in fruits, vegetables, legumes, grains and lean proteins. Eat less sugary foods and choose healthier fats. The Mediterranean diet is often recommended. This diet is based on healthy whole foods and includes very few processed foods. Predominate intake of vegetables, fruits, whole grains, and legumes. Fish, poultry, and eggs are consumed in moderation, with red meat limited. Use of healthy fats such as extra virgin olive oil and moderate intake of dairy i.e. yogurt and cheese

  • Exercise – regular physical activity. Try to be more active for at least 60 minutes a day. It will likely require time to build into this routine

  • Managing associated conditions – such as diabetes, hypertension, and high cholesterol

  • Assessment of overall cardiovascular risk (heart disease and stroke is major cause of death in MAFLD)

  • Keep up to date with cancer screening

  • To keep alcohol consumption at recommended levels, aim for no more than 10 standard drinks per week and no more than 4 standard drinks on any one day

  • Monitoring and treatment of cirrhosis (if present)

For alcohol-related liver disease:

What is the outlook for people with MAFLD?

If detected early, fatty liver disease is often reversible with lifestyle changes. However, without intervention, inflammation and scarring can progress to cirrhosis, liver failure, or liver cancer in some individuals.

For people with early-stage fatty liver disease, regular monitoring is recommended with your GP. Your doctor will assess liver health every few years using routine blood tests, non-invasive tests ( FIB-4 score which is based on blood tests and demographic factors +/- liver elastography) to check for scarring (fibrosis). Ongoing management also includes monitoring your overall metabolic health, cardiovascular risk and cancer screening.

Those with more advanced disease should be referred to a specialist liver doctor (gastroenterologist) for ongoing monitoring and treatment.