What Is the Most Common Cause of Hepatic Steatosis?

The main risk factor for alcoholic fatty liver disease (AFLD) is drinking heavy amounts of alcohol. Men who consume 40 to 80 grams of alcohol per day and women who consume 20 to 40 grams of alcohol per day over 10 to 12 years are at a high risk of severe AFLD.

Five heavy alcohol consumption risk factors for AFLD include:

1. Older age
2. Genetics
3. Obesity
4. Smoking
5. History of certain infections, such as hepatitis C

Seven major risk factors for nonalcoholic fatty liver disease (NAFLD) include:

1. Overweight or obesity
2. Insulin resistance
3. Type II diabetes
4. High cholesterol
5. High triglycerides
6. Metabolic syndrome
7. African American or Hispanic man

Nine other risk factors for NAFLD include:

1. Having a family history of liver disease
2. Taking certain medications, such as Trexall (methotrexate), Nolvadex (tamoxifen), and Pacerone (amiodarone)
3. Pregnancy
4. A history of certain infections, such as hepatitis C
5. Polycystic ovary syndrome
6. Obstructive sleep apnea
7. Exposure to certain toxins
8. Rapid weight loss
9. Rare genetic conditions such as Wilson disease or hypobetalipoproteinemia

Remember that having risk factors means you’re at an increased risk of fatty liver disease compared with people who don’t have risk factors. It does not mean you’ll certainly develop it in the future.

If you have one or more risk factors for fatty liver disease, talk with your healthcare professional about prevention strategies.

Hepatic steatosis is also known as fatty liver. It occurs when fat builds up in the liver. Having a small amount of fat in your liver is normal, but too much can become a health problem. It helps process nutrients from food and drinks and filters harmful substances from your blood.

• When hepatic steatosis develops in someone who drinks a lot of alcohol, it’s known as alcoholic fatty liver disease.
• In someone who doesn’t drink a lot of alcohol, hepatic steatosis is known as nonalcoholic fatty liver disease.
• Liver damage due to cirrhosis is permanent. That’s why it’s so important to prevent it from developing in the first place.

Fifteen signs and symptoms of hepatic steatosis include:

1. Abdominal pain
2. Loss of appetite
3. Weight loss
4. Weakness or fatigue
5. Nausea
6. Itchy skin
7. Yellow skin and eyes
8. Easy bruising or bleeding
9. Dark-colored urine
10. Pale stools
11. Ascites (fluid accumulation in the abdomen)
12. Swelling (edema) of your legs
13. Web-like clusters of blood vessels under your skin
14. Breast enlargement in men
15. Confusion

To diagnose fatty liver, your healthcare professional will take your medical history, conduct a physical exam and order one or more tests.

If your doctor suspects that you might have fatty liver, they will likely ask you questions about the following:

• Family medical history, including any history of liver disease
• Alcohol consumption and other lifestyle habits
• Any medical conditions you might have
• Any medications you might take
• Recent changes in your health

Let your doctor know if you’ve been experiencing fatigue, loss of appetite, or other unexplained symptoms.

Physical exam

To check for liver inflammation, your doctor may palpate or press on your abdomen. If your liver is enlarged, they might be able to feel it. However, your liver can be inflamed without being enlarged. 

Blood tests

• Complete blood count
• Liver enzymes and liver function tests
• Tests for chronic viral hepatitis (hepatitis A, hepatitis C, and others)
• Celiac disease screening test
• Fasting blood sugar
• Hemoglobin A1C, which shows how stable your blood sugar is
• Lipid profile, which measures blood fats, such as cholesterol and triglycerides

Imaging studies

Your doctor may use one or more of the following imaging tests to check for excess fat or other problems with your liver:

• Ultrasound exam
• Computed tomography scan
• A magnetic resonance imaging scan
• Transient elastography

Liver biopsy

It is a small surgical procedure that involves removing a sample of liver tissue to determine the extent of liver damage. It is most commonly done in the liver cirrhosis stage.

Currently, no medications have been approved to treat fatty liver disease.

• Usually, the first line of treatment is to lose weight. It helps reduce fat, inflammation, and scarring in your liver. Losing just three to five percent of your body weight can cut down a significant amount of fat in your liver. Weight loss surgery is an option if you have a lot to lose.
• More research is needed to develop and test medications to treat this condition.

In many cases, lifestyle changes can help reverse most stages of fatty liver disease. For example, your doctor might advise you to:

• Limit or avoid alcohol.
• Take steps to lose weight.
• Make changes to your diet.
• Avoid medications and supplements that are hard on your liver.

If you have alcoholic fatty liver disease, your doctor will instruct you to completely abstain from alcohol. They may recommend a detoxification program and counseling if you have alcohol use disorder.

Several viral infections can damage the liver. To protect your liver health, your doctor may advise you to receive vaccines for hepatitis A and hepatitis B. Depending on your situation, they may also recommend regular screenings for hepatitis C.

If you have complications due to nonalcoholic steatohepatitis (NASH) such as cirrhosis or liver failure, you may need to have a liver transplant. In general, people with NASH who get a liver transplant do very well.

Other lifestyle changes for hepatic steatosis include:

• Eat a nutrient-rich diet that’s low in calories, saturated fat, and trans fats
• Get at least 30 minutes of exercise most days of the week

Always talk with your doctor before you try a new supplement or natural remedy. Some supplements or natural remedies might put stress on your liver or interact with the medications you’re taking.

Hepatic steatosis, characterized by the buildup of fat in the liver, is closely associated with metabolic disease and may progress to liver cirrhosis and hepatocellular carcinoma. With the increasing prevalence of hepatic steatosis, interest in the effects of hepatic steatosis on other diseases such as hepatitis B is also increasing.

• In many cases, it’s possible to reverse hepatic steatosis through lifestyle changes, such as limiting alcohol, adjusting diet, and managing weight. These changes may help prevent further liver damage and scarring.
• For alcoholic fatty liver disease, in particular, it’s important to abstain from alcohol use entirely. If you need help with not drinking alcohol, consider engaging in a detoxification program and counseling.
• When left untreated, hepatic steatosis can progress to inflammation, fibrosis, and cirrhosis. Scarring due to cirrhosis isn’t reversible. If you develop cirrhosis, it increases your risk of liver cancer and liver failure. These complications can be life-threatening.

Generally speaking, the outcome for hepatic steatosis is best when treatment begins in the early stages, before fibrosis and cirrhosis.