Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a common condition where fat builds up in your liver. The NHS says it is often linked to being overweight and can usually be treated with healthy lifestyle changes. It is also known as metabolic dysfunction-associated steatotic liver disease, or MASLD, which is the name the charity Liver UK now uses.

The NHS describes four stages:

• fatty liver (steatosis), a build-up of fat with no damage to the liver
• MASH, where the fat has caused inflammation
• fibrosis, where there is scarring but the liver usually still works well
• cirrhosis, where severe damage affects how well the liver works

Most people only have the first stage, which does not usually cause problems. A small number go on to the later stages, and the NHS says lifestyle changes can help prevent this.

Fatty liver disease does not usually cause any symptoms, and most people find out when they have tests for another reason. When there are symptoms, the NHS lists:

• feeling very tired
• feeling generally unwell
• pain or discomfort under the right side of your ribs

Because symptoms are uncommon, the risk factors tell you more. The NHS lists:

• being overweight, particularly with a lot of fat around your stomach and waist
• an unhealthy diet or too little physical activity
• type 2 diabetes
• high blood pressure or high cholesterol
• being over 50

Fat around the waist is the fat described on the visceral fat page. The NHS also lists fatty liver disease among the conditions that metabolic syndrome makes more likely.

Fatty liver is usually found when a blood test, such as a liver function test, or a scan done for another reason shows signs of a problem with your liver. A liver function test is a blood test that checks how well your liver is working. The NHS says that when a GP suspects fatty liver disease, they ask about your symptoms, check your height, weight and waist, and ask how much alcohol you drink, to rule out alcohol-related liver disease.

Your GP may then arrange more blood tests, and sometimes an ultrasound scan of your tummy, to:

• confirm there is a build-up of fat in your liver
• rule out other causes of liver problems
• find out if there is any damage to your liver
• check for linked conditions, such as kidney problems

Medical Weight Loss London does not arrange scans. If you need an ultrasound, your GP arranges it.

The main treatment for fatty liver disease is a set of healthy lifestyle changes, and losing weight if you are overweight is one of the most important. The NHS says these changes can reduce the build-up of fat in your liver and help repair any damage or stop it getting worse. Its advice is to:

• eat a healthy, balanced diet
• exercise regularly, aiming for at least 150 minutes a week
• lose weight if you are overweight
• keep to no more than 14 units of alcohol a week
• stop smoking

The NHS says most people need no other treatment unless the liver is already damaged. You should have check-ups at least once a year and tests every 2 to 3 years. If tests show scarring (fibrosis) or cirrhosis, you will need to see a liver specialist in hospital. The same changes lower the risk of heart disease, kidney disease, high blood pressure and type 2 diabetes.

If you are overweight, losing weight reduces the fat stored in your liver. Diabetes UK notes that losing even small amounts of weight can reduce the fat inside the liver and pancreas, and the NHS advises a safe rate of about 0.5 to 1kg a week.

What helps the weight you lose come from fat:

• an energy deficit you can keep up for months
• resistance training two or three times a week, to protect muscle
• enough protein at each meal
• alcohol kept within 14 units a week, or less

Watch your waist as well as your weight, because the NHS singles out fat around the stomach and waist as a risk. A medical weight loss programme builds the plan around your blood results and repeats them at review, so you can see whether your liver tests are changing.

There is no special diet plan for fatty liver disease: Liver UK says most people benefit from a healthy, well-balanced diet eaten most of the time. It gives the Mediterranean diet as one example, built on plant foods with smaller amounts of meat and dairy. Its getting-started advice is to:

• eat at least 5 portions of different fruit and vegetables a day
• include wholegrain starchy foods such as bread, rice, pasta and potatoes
• choose protein such as beans, pulses, lentils, eggs, nuts or lean meat
• have two portions of fish a week, one of them oily, if you eat fish
• use unsaturated oils such as olive or rapeseed oil, in small amounts
• drink water, lower-fat milk or sugar-free tea and coffee

Liver UK also suggests planning meals, checking food labels and weighing portions. If you find it hard to change, it suggests asking for a referral to a dietitian with experience of MASLD.

See a GP if you think you could have fatty liver disease or are at higher risk of it, and get help sooner if you notice any sign of more serious liver disease:

• yellow skin or yellow whites of the eyes (jaundice): ask for an urgent GP appointment or contact NHS 111
• darker pee, paler poo or itchy skin alongside that yellowing
• a swollen tummy, legs, ankles or feet
• vomiting blood, or very dark or black poo: call 999 or go to A&E

These signs need a diagnosis first, and a weight programme is the wrong place to start. If eating or your weight is causing you distress, speak to your GP or contact Beat.

A first assessment arranged by Medical Weight Loss London at UNTIL Soho measures your waist, weight and blood pressure, asks about alcohol, and arranges the blood tests that matter for a fatty liver: liver function, HbA1c and a lipid profile, with kidney function and a full blood count. If the results point to your liver, your GP can arrange an ultrasound. First assessments at London clinics cost about £150 to £310, with tests on top (what a programme costs).

The terms are explained in the weight management glossary. Ask what to get checked and UNTIL Health Concierge arranges the appointment with a registered clinician.