Fatty Liver Disease Symptoms Are Often ‘Silent’: MDs Explain What To Look For

You probably know someone with non-alcoholic fatty liver disease or have heard about the condition before (even if you're not totally sure what it is). That's because fatty liver is common, affecting nearly a quarter of US adults, according to the National Institutes of Health . The problem: It's often referred to as a "silent" disease, since it can develop without symptoms or with symptoms that are so minor they're easy to write off. So, what are the fatty liver disease symptoms you should watch for, and how can you tell if you're at risk? Here, we break down everything you need to know.

What is non-alcoholic fatty liver disease?

First things first: Non-alcoholic fatty liver disease was recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD). An article from Hepatology explains that the change was made to better reflect the actual health condition.

Regardless of the name, MASLD is very common and on the rise. In fact, a study in Diabetes Spectrum suggests incidences of fatty liver have increased by 50% in the last 30 years. And that number is higher for those with conditions like type 2 diabetes. Upwards of 66% of people with diabetes are thought to also have fatty liver disease, reports the National Institute of Diabetes and Digestive and Kidney Diseases .

As Sheena B. Patel, MD , a gastroenterologist with Gastro Health in Ohio, explains, MASLD is “an abnormal accumulation of fat in the liver.” But what exactly constitutes an abnormal amount of fat? The condition occurs when more than 5% of the cells in the liver have fat droplets, adds Kathleen Corey, MD, MPH , director of the Massachusetts General Hospital Fatty Liver Clinic in Boston.

For some people, “that fat in the liver causes the liver to be inflamed,” she notes. “And when it’s chronically inflamed, it can lay down scar tissue called fibrosis.” If there’s significant fibrosis, you can develop cirrhosis of the liver. That can raise the risk of liver cancer or a liver transplant. Once the disease reaches a point where scar tissue develops, it’s called metabolic dysfunction-associated steatohepatitis, or MASH.

For other people, fatty liver disease won’t progress to the point of causing scar tissue. But having the condition can put you at risk for diabetes and heart disease, says Dr. Corey.

What causes non-alcoholic fatty liver disease?

“It’s probably a combination of environment and genetics,” explains Dr. Corey, who says there are genes associated with an increased risk of MASLD.

Certain conditions, including diabetes, high blood pressure, high cholesterol, high triglycerides and carrying excess weight also increase your risk, she says. And factors like the high prevalence of processed foods and difficulty in being able to get physical activity also contribute to fatty liver, Dr. Corey adds.

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Menopause may play a role, too. Typically, younger men have higher rates of fatty liver than younger women. “But when menopause happens, all of a sudden it equals out,” Dr. Corey says. The exact reason behind this isn’t yet clear. “Whether it’s estrogen deprivation, whether it’s changes in androgens, we don’t know."

Fatty liver disease symptoms

“Most people are asymptomatic,” says Dr. Corey. Some people may feel discomfort in the upper right side of their abdomen, which she describes as more of a pressure or fullness than a sharp pain. You may also feel tired or just generally unwell, adds Dr. Patel.

“Most of the time, patients see their primary care provider," Dr. Patel explains. "During routine blood work, they may have elevations of their liver enzymes. Consequently, they will get an ultrasound of their liver or some sort of imaging, and that will show it."

But even blood tests don’t always tell the whole story. Testing liver enzymes or liver functions can be (but isn’t always) part of a routine blood panel. And “blood tests are not elevated in the majority of people,” says Dr. Corey.

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Fatty liver disease often doesn’t have noticeable symptoms

Some people find out they have fatty liver disease inadvertently. “They come to clinical attention either because that have steatosis, or fat in their liver, noticed on imaging that’s done for other reasons," reiterates Dr. Corey. "Say you have a CAT scan because of a kidney stone, [your doctor may notice] that you also have fat in the liver — or because you have abnormal liver blood tests."

That said, Dr. Corey advises advocating for yourself if you’re at a higher risk. For instance, if you have diabetes or high blood pressure or are overweight. “It’s important to know that people have it so that they can act upon it,” she says. “For people who have those risk factors, it’s definitely worth a discussion with their provider.”

That’s because MASLD can be reversed, especially if caught early, says Dr. Corey. Typically, this involves losing weight and/or getting conditions like diabetes under control. Losing just 5% of your body weight may improve MASLD, while cutting 7 to 10% can help reverse MASH, suggests a study in Current Obesity Reports . Reversal will typically take a year or so. That said, Dr. Patel notes she’s also had patients who lose a significant amount of weight see signs of reversal in as little as six months.

More ways to manage, and even reverse, fatty liver disease:

Top Doctors Reveal Their 7 Best Fatty Liver Disease Self-Care Tips

Can Fatty Liver Be Reversed? Doctors Say This Simple Drink Swap Can Help

Doctor + Nutritionist: 10 Easy Ways To Heal a Fatty Liver Fast To Boost Fat Burn by 400%

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan .