Fatty liver (steatosis) is the build-up of fat in your liver. If too much fat builds up, it can progress to inflammation, scarring and potentially liver failure. You’re more likely to develop fatty liver if you drink too much alcohol or carry excess weight around your waist. But you can prevent and reverse fatty liver diseases with some simple lifestyle changes.

What is fatty liver disease?

Fatty liver (steatosis) is the build-up of fat in your liver. If too much fat builds up, it can progress to inflammation, liver cirrhosis (scarring), and potentially liver failure.


Fatty liver is a key part of developing non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD). AFLD refers to fatty liver disease from drinking alcohol. NAFLD includes fat build-up from all causes unrelated to alcohol or drug consumption, hepatitis infection, or inherited conditions. 


Fatty liver is the first step in NAFLD, leading to inflammation and scarring, whereas it comes secondary to alcohol-induced inflammation in AFLD.

You can check your liver health at home by using a liver blood test (formerly known as a liver function blood test or LFT). This test can be useful if you believe you are at risk of fatty liver disease and have persistent symptoms like nausea and fatigue. 

But it can’t diagnose or rule out liver disease without further investigation from your GP or full medical context.

When doing this liver blood test, one of our GPs will review your:

  • previous liver blood test results (if you have any)
  • health profile 
  • body mass index (BMI)
  • alcohol consumption
  • diet

Fatty liver symptoms

Fatty liver often causes no symptoms, but you might experience tiredness and discomfort in your upper right abdomen where your liver is.


If fatty liver progresses to cirrhosis (permanent scarring), you might have:

  • yellow skin and eyes (jaundice)
  • dark urine
  • confusion and memory loss
  • swelling of your abdomen (ascites) or legs (oedema)

Fatty liver causes

There are many fatty liver causes, but you’re more likely to develop it if you:

  • drink more than 14 units of alcohol a week regularly
  • carry excess weight — particularly around your waist
  • eat a diet high in fat and carbohydrates 
  • smoke
  • have type 2 diabetes
  • have high blood pressure

Wine glass on shelf next to plant


Consistently drinking a lot of alcohol is a major cause of fatty liver disease — 90% of heavy drinkers have some degree of fatty liver. This happens because the alcohol prevents the breakdown of fats, so they stay in your liver instead.


Similarly, obesity might lead to fatty liver disease because excess fat in your body struggles to get stored normally. It then ends up in organs that it usually wouldn’t — especially in your liver. 


High levels of fat and sugar are associated with more fatty deposits in your liver and an increased risk of type 2 diabetes and cardiovascular disease.


Even with all these risk factors, it doesn’t mean you’ll always develop fatty liver disease — 15% of people who drink more than 3 drinks a day don’t have fatty liver.  

Fatty liver treatment

You can reverse fatty liver diseases with lifestyle changes before they progress to more serious conditions. Fatty liver treatment can focus on minimising the lifestyle factor that has caused it, or general lifestyle changes that improve liver health.


If you have alcoholic fatty liver, it’s recommended to at least cut down your alcohol consumption or stop drinking altogether. The current UK guidelines are to drink no more than 14 units a week regularly. Find out more about the effects of alcohol on your body.


As obesity is such a risk factor for fatty liver, managing your weight can be beneficial. 


Exercising regularly without weight loss is also beneficial for reducing fat build-up in your liver and your risk of developing NAFLD.


Because of your liver’s role in metabolism, dietary changes are an essential part of fatty liver treatment. The Mediterranean diet is a good option as it involves eating lots of vegetables, whole grains and unsaturated fats while eating little saturated fat, salt and added sugar. A fatty liver diet like this can reduce fat deposits in your liver and improve insulin resistance. It’s also beneficial for lowering high blood pressure and managing obesity. You should always consult your doctor or a registered dietician before changing your diet. 


Research shows that eating a balanced diet and exercising might be more effective at treating fatty liver disease than dietary changes alone.

Thriva podcast | S3 E2: Wine


Akhavan Rezayat, A., Dadgar Moghadam, M., Ghasemi Nour, M., Shirazinia, M., Ghodsi, H., Rouhbakhsh Zahmatkesh, M. R., ... & Akhavan Rezayat, K. (2018). Association between smoking and non-alcoholic fatty liver disease: A systematic review and meta-analysis. SAGE open medicine, 6, 2050312117745223.


Altamirano, J., & Bataller, R. (2011). Alcoholic liver disease: pathogenesis and new targets for therapy. Nature reviews Gastroenterology & hepatology, 8(9), 491-501.


Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K., ... & Sanyal, A. J. (2012). The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology, 142(7), 1592-1609.


D’Innocenzo, S., Biagi, C., & Lanari, M. (2019). Obesity and the mediterranean diet: a review of evidence of the role and sustainability of the mediterranean diet. Nutrients, 11(6), 1306.


Emdin, C. A., Haas, M., Ajmera, V., Simon, T. G., Homburger, J., Neben, C., ... & Khera, A. V. (2021). Association of Genetic Variation With Cirrhosis: A Multi-Trait Genome-Wide Association and Gene–Environment Interaction Study. Gastroenterology, 160(5), 1620-1633.


Franco, I., Bianco, A., Mirizzi, A., Campanella, A., Bonfiglio, C., Sorino, P., ... & Osella, A. R. (2021). Physical activity and low glycemic index Mediterranean diet: Main and modification effects on NAFLD score. Results from a randomized clinical trial. Nutrients, 13(1), 66.        

Jia, G. Y., Han, T., Gao, L., Wang, L., Wang, S. C., Yang, L., ... & Di, F. S. (2018). Effect of aerobic exercise and resistance exercise in improving non-alcoholic fatty liver disease: a randomized controlled trial. Zhonghua gan zang bing za zhi= Zhonghua ganzangbing zazhi= Chinese journal of hepatology, 26(1), 34-41.


Jung, C. H., & Choi, K. M. (2017). Impact of high-carbohydrate diet on metabolic parameters in patients with type 2 diabetes. Nutrients, 9(4), 322.


Magriplis, E., Panagiotakos, D., Kyrou, I., Tsioufis, C., Mitsopoulou, A. V., Karageorgou, D., ... & Zampelas, A. (2020). Presence of hypertension is reduced by Mediterranean diet adherence in all individuals with a more pronounced effect in the obese: the Hellenic National Nutrition and Health Survey (HNNHS). Nutrients, 12(3), 853.


Mitra, S., De, A., & Chowdhury, A. (2020). Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Translational gastroenterology and hepatology, 5.


Mota, M., Banini, B. A., Cazanave, S. C., & Sanyal, A. J. (2016). Molecular mechanisms of lipotoxicity and glucotoxicity in nonalcoholic fatty liver disease. Metabolism, 65(8), 1049-1061.


Newton, J. L. (2010). Systemic symptoms in non-alcoholic fatty liver disease. Digestive diseases, 28(1), 214-219.


Parker, R., Aithal, G. P., Becker, U., Gleeson, D., Masson, S., Wyatt, J. I., ... & WALDO study group. (2019). Natural history of histologically proven alcohol-related liver disease: a systematic review. Journal of hepatology, 71(3), 586-593.


Polyzos, S. A., Kountouras, J., & Mantzoros, C. S. (2019). Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics. Metabolism, 92, 82-97.


Purohit, V., Gao, B., & Song, B. J. (2009). Molecular mechanisms of alcoholic fatty liver. Alcoholism: Clinical and Experimental Research, 33(2), 191-205.


Ryan, M. C., Itsiopoulos, C., Thodis, T., Ward, G., Trost, N., Hofferberth, S., ... & Wilson, A. M. (2013). The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. Journal of hepatology, 59(1), 138-143.

 Sozio, M., & Crabb, D. W. (2008). Alcohol and lipid metabolism. American Journal of Physiology-Endocrinology and Metabolism, 295(1), E10-E16.


Thoma, C., Day, C. P., & Trenell, M. I. (2012). Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review. Journal of hepatology, 56(1), 255-266.


Winn, N. C., Liu, Y., Rector, R. S., Parks, E. J., Ibdah, J. A., & Kanaley, J. A. (2018). Energy-matched moderate and high intensity exercise training improves nonalcoholic fatty liver disease risk independent of changes in body mass or abdominal adiposity—a randomized trial. Metabolism, 78, 128-140.

UK Chief Medical Officers. (2016). UK Chief Medical Officers’ Low Risk Drinking Guidelines. Retrieved 2 December 2021 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf.