Causes

• Obesity and overweight
• Type 2 diabetes mellitus and insulin resistance
• Dyslipidemia (high triglycerides and cholesterol)
• Excess alcohol consumption
• Sedentary lifestyle and unhealthy diet
• Certain medications (e.g., steroids, amiodarone)
• Genetic predisposition

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Types

• Non-Alcoholic Fatty Liver Disease (NAFLD): Occurs in individuals with little or no alcohol intake; commonly associated with metabolic syndrome
• Alcoholic Fatty Liver Disease (AFLD): Caused by chronic alcohol consumption

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Clinical Features

• Often asymptomatic in early stages
• Fatigue and general weakness
• Mild discomfort or heaviness in the right upper abdomen
• Hepatomegaly (enlarged liver)
• In advanced disease: jaundice, edema, ascites

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Laboratory Findings

• Mild elevation of liver enzymes (ALT, AST)
• Elevated triglycerides and cholesterol
• Increased fasting glucose or HbA1c
• Additional tests to exclude viral or autoimmune liver disease

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Investigations

• Ultrasound abdomen: First-line, detects fatty infiltration
• FibroScan (Transient Elastography): Assesses liver stiffness and fibrosis
• Blood tests: Liver function tests, lipid profile, glucose, HbA1c
• MRI-PDFF: Quantifies liver fat in selected cases
• Liver biopsy: Gold standard (rarely required)

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Management

• Weight reduction through diet and regular exercise
• Control of diabetes, hypertension, and dyslipidemia
• Avoidance of alcohol and hepatotoxic drugs
• Balanced diet rich in fruits, vegetables, whole grains, and lean protein
• Regular monitoring and follow-up
• Pharmacological therapy in selected patients under medical supervision

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Summary

Fatty liver is a largely preventable and reversible condition when identified early. Lifestyle modification remains the cornerstone of management, with regular medical follow-up to prevent progression to advanced liver disease.
Grades of Fatty Liver

Fatty liver is commonly graded based on the amount of fat accumulation seen on imaging (usually ultrasound):

Grade 1 (Mild)

• Slight increase in liver fat
• Usually asymptomatic
• Liver function is typically normal
• Fully reversible with lifestyle changes

Grade 2 (Moderate)

• Moderate fat accumulation in the liver
• May have mild symptoms like fatigue or abdominal discomfort
• Liver enzymes may be mildly elevated
• Requires active lifestyle and metabolic control

Grade 3 (Severe)

• Marked fat accumulation with possible inflammation
• Higher risk of fibrosis and progression to cirrhosis
• May present with more noticeable symptoms
• Needs strict medical follow-up and management

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Key Point

Early-stage fatty liver (Grade 1 and 2) is often reversible with proper diet, exercise, and control of diabetes and cholesterol. Early detection is essential to prevent progression.