Fatty liver develops when the liver begins storing more fat than it can process. Several clinical and lifestyle factors contribute to this accumulation. Understanding these causes helps guide targeted treatment.
Common causes
1. Insulin resistance
This is the most central driver. When cells become less responsive to insulin, the body produces more of it. High insulin levels stimulate fat storage in the liver and reduce fat breakdown.
2. Excess body weight
Abdominal obesity increases the flow of fatty acids from visceral fat to the liver. Even a modest weight reduction improves liver fat significantly.
3. High intake of refined carbohydrates and sugars
Frequent consumption of white rice, bakery items, sugary drinks, sweets, and high fructose products overloads the liver and increases fat synthesis.
4. Sedentary lifestyle
Low physical activity reduces muscle glucose uptake and increases metabolic load on the liver.
5. Dyslipidemia
High triglycerides and low HDL levels correlate strongly with liver fat accumulation. This pattern often accompanies insulin resistance.
6. PCOS
Women with polycystic ovarian syndrome often have insulin resistance and hormonal imbalance, contributing to fatty liver.
7. Diabetes and prediabetes
Poor glucose control leads to higher fat deposition in the liver over time.
8. Hypothyroidism
Low thyroid hormones slow metabolism, increasing fat buildup.
9. Certain medications
Some drugs such as steroids, tamoxifen, methotrexate, and valproate can contribute to liver fat accumulation in susceptible individuals.
10. Alcohol use
Even moderate intake can aggravate fat deposition in those who already have metabolic fatty liver.
11. Genetics and ethnicity
Certain genetic variants increase susceptibility, particularly in South Asian populations who develop metabolic disease at lower BMI.
Diagnosing fatty liver
Ultrasound and FibroScan are used for diagnosis and assessment of Fatty Liver.
Both tests are used to evaluate fatty liver, but they serve different purposes and offer different levels of precision.
Ultrasound (USG Abdomen)
This is usually the first screening test. It detects changes in liver brightness caused by fat accumulation.
Advantages: widely available, affordable, non invasive.
Limitations: cannot quantify liver stiffness or fat percentage. Sensitivity reduces in early stages or in individuals with higher body fat. Grading is subjective and depends on the operator.
FibroScan (Transient Elastography)
This is a specialised test that measures liver stiffness and controlled attenuation parameter. Stiffness reflects fibrosis, while attenuation reflects the degree of fat.
Advantages: provides numerical values, helps differentiate simple fatty liver from early fibrosis, repeatable for monitoring progress. More accurate than ultrasound for staging.
Limitations: slightly higher cost, availability mainly in specialised centres, may be affected by severe obesity or ascites.
Summary for clinical decision making
Ultrasound is a good starting point to detect fatty changes. FibroScan adds clarity by quantifying fat and assessing scarring. When ultrasound reports fatty liver or when risk factors like diabetes, obesity, PCOS or abnormal liver enzymes are present, FibroScan provides a more complete picture to guide treatment and follow up.
Fatty liver has emerged as a common silent condition in routine practice. Many individuals discover it incidentally during an ultrasound, yet it deserves early attention because the liver responds remarkably well to timely correction. Understanding its stages, reversibility, and structured treatment helps prevent long term complications.
Understanding the Grades of Fatty liver:
Grade 1 indicates mild fat infiltration with preserved liver function. Most people remain symptom free at this stage.
Grade 2 represents moderate accumulation where metabolic markers often start to show disturbance.
Grade 3 shows significant fatty infiltration that interferes with the visibility of deeper liver structures. This stage carries a higher risk of inflammation and progressive tissue injury.
Reversibility
Grades 1 and 2 are often fully reversible with consistent lifestyle and dietary intervention. Even Grade 3 can improve considerably when underlying metabolic issues are addressed. The liver has an impressive regenerative ability, provided the internal environment is corrected. Recovery timelines may range from three months to one year depending on severity and adherence.
What happens if fatty liver is not treated
Untreated fatty liver can progress slowly through predictable stages:
Steatohepatitis
Fat begins to irritate liver cells, leading to inflammation. This is known as non alcoholic steatohepatitis, a more serious stage where liver enzymes rise and active tissue damage starts.
Fibrosis
Ongoing inflammation results in scarring. Although the liver still performs most functions, this stage signals reduced healing capacity and higher risk of progression.
Cirrhosis
Advanced scarring disrupts normal liver structure and reduces its ability to carry out essential tasks such as metabolic regulation, detoxification, and protein synthesis. Cirrhosis produces complications such as fluid retention, bleeding tendencies, increased infection risk, and reduced liver reserve. This stage is not fully reversible.
Increased metabolic risk
Fatty liver rarely exists alone. When untreated, it increases the likelihood of abdominal obesity, insulin resistance, diabetes, dyslipidemia, cardiovascular disease, and polycystic ovarian syndrome. The liver plays a central role in metabolic balance, and its deterioration further worsens these conditions.
Risk of liver cancer
Long standing cirrhosis increases the risk of hepatocellular carcinoma, making regular surveillance necessary.
Treatment of Fatty Liver
Nutrition therapy
Correcting insulin resistance through balanced, evidence based dietary planning is essential. A structured plan focuses on controlled carbohydrate quality, adequate protein, healthy fats, and significant reduction of fructose and trans fats. In overweight individuals, a weight loss of seven to ten percent is strongly associated with reversal of fatty liver.
Physical activity
Brisk aerobic activity combined with resistance training improves fat metabolism in the liver and reduces inflammation. Even twenty to thirty minutes daily offers measurable benefit.
Medical evaluation
Screening for diabetes, thyroid imbalance, dyslipidemia, PCOS, and vitamin deficiencies supports comprehensive management. Physicians may consider specific medications such as insulin sensitizers or vitamin E for selected patients.
Lifestyle correction
Adequate sleep, stress management, avoidance of alcohol, and reduction of ultra processed foods create a favourable environment for liver recovery.
Conclusion
Fatty liver is largely reversible when addressed early. A structured, personalised approach brings predictable improvement in most patients. For detailed assessment and tailored nutrition therapy, you may contact Dr Sumaiya’s NutriCare Clinic, phone number 7208660987, email doc@drsumaiya.com, 7, Moore Rd, off Coles Road, Pulikeshi Nagar, Frazer Town, Bengaluru, Karnataka 560005.
