What Causes Fatty Liver Disease?
Jake Newby
| 3 min read
Jake Newby is a brand journalist for Blue Cross Blue...
Key Takeaways
- Fatty liver disease can develop silently for years, making early awareness of metabolic risks and alcohol use especially important.
- MASLD, the most common type of fatty liver disease, is closely linked to obesity, diabetes, high blood pressure and cholesterol issues.
- Early-stage fatty liver disease can often improve through weight loss, healthier eating habits, regular exercise and reduced alcohol consumption.
- Identifying fatty liver disease before significant scarring occurs offers the best chance to prevent cirrhosis, liver failure and other complications.
Did you know your liver can accumulate fat for years without sending your body an obvious warning signal? That’s why understanding the causes of fatty liver disease is important.
Fatty liver disease – also called steatotic liver disease – occurs when excess fat builds up in liver cells. The most common causes are metabolic health problems and heavy alcohol use. Certain medications, infections and genetic or metabolic disorders may also contribute.
What to know about fatty liver disease related to alcohol
Alcohol-associated liver disease develops when excessive alcohol use damages liver cells and interferes with the liver’s ability to process fat.
Early fat buildup may improve when alcohol use stops, especially before significant liver scarring occurs. But continued heavy drinking can lead to alcohol-associated hepatitis, fibrosis and cirrhosis.
What is MASLD?
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of fatty liver disease. It was previously called nonalcoholic fatty liver disease, or NAFLD.
The terminology changed in 2023 to emphasize the role of metabolic health. MASLD involves liver fat, according to the American Association for the Study of Liver Diseases, plus at least one cardiometabolic risk factor, such as:
- Overweight or obesity
- Type 2 diabetes, prediabetes or insulin resistance
- High blood pressure
- High triglycerides
- Low HDL, or “good” cholesterol
People can also have metabolic risk factors and consume alcohol. A related classification called MetALD describes this overlap.
Some people with MASLD develop metabolic dysfunction-associated steatohepatitis (MASH), which involves liver inflammation and cell damage, increasing the risk of fibrosis, cirrhosis and liver cancer.
| Alcohol-Related Fatty Liver Disease | MASLD (Metabolic Fatty Liver Disease) | |
| Primary Cause | Heavy or long-term alcohol use | Obesity, diabetes, insulin resistance, high blood pressure, abnormal cholesterol levels |
| Fat Buildup in Liver | Yes | Yes |
| Early Symptoms | Often none | Often none |
| Common Symptoms | Fatigue, abdominal discomfort, loss of appetite | Fatigue, abdominal discomfort, enlarged liver |
| Risk of Progression | Risk of Progression Alcoholic hepatitis, cirrhosis | MASH, fibrosis, cirrhosis |
| Key Treatment | Stop drinking alcohol | Weight loss, exercise, improved metabolic health, diabetes management |
| Is it Reversible? | Often, if caught early and alcohol use stops | Often, particularly with meaningful lifestyle changes |
What are fatty liver disease symptoms?
Fatty liver disease is sometimes referred to as a “silent” condition because many people who experience it have no symptoms. When symptoms do occur, they may include fatigue, weakness and discomfort in the upper-right abdomen.
Advanced liver disease may cause jaundice, abdominal or leg swelling, severe itching, easy bleeding or confusion. These symptoms require swift medical attention.
Because symptoms alone cannot confirm fatty liver disease, a doctor may use blood tests, imaging, liver-stiffness testing or, less commonly, a liver biopsy.
Can fatty liver disease be reversed?
Early liver fat can often be reduced and may sometimes be reversed. Liver inflammation and some fibrosis may also improve. Established cirrhosis is less likely to reverse, although treatment can slow its progression, according to research.
Gradual weight loss can improve MASLD in people with overweight or obesity. The American College of Gastroenterology notes that losing about 10% of body weight may reduce liver fat and inflammation and potentially improve scarring.
Helpful lifestyle tweaks that can reduce your change of fatty liver disease include:
- Exercising regularly
- Eating more vegetables, whole grains and lean proteins
- Limiting added sugars and highly processed foods
- Managing diabetes, blood pressure and cholesterol
- Avoiding or limiting alcohol as advised by a doctor
Talk with your primary care provider if you have metabolic risk factors, abnormal liver tests or concerns about alcohol use. Finding fatty liver disease early provides the best opportunity to protect your liver and overall health.
Experts suggest heavy drinkers talk with a healthcare provider. Blue Cross Blue Shield of Michigan and Blue Care Network can help members find an in-network mental health professional by calling behavioral health access lines listed below:
PPO: Behavioral Health Access Line | 1-800-762-2382
A free and confidential resource that’s just a call away when you need immediate support. Behavioral health professionals answer, 24/7.
HMO: Behavioral Health Access Line | 1-800-482-5982
Connect with a behavioral health clinician if you need help finding a mental health or substance use provider.
Behavioral health clinicians are available for routine assistance from 8 a.m. to 5 p.m., Monday through Friday. For urgent concerns after hours, clinicians are also available 24 hours a day, seven days a week.
Photo credit: Getty Images
