How do you know if you have a fatty liver? Steatosis is painless, symptoms only become apparent when the liver is severely damaged. Watch out for alcohol and fatty foods

One interesting fact. Steatosis was first called liver steatosis. Since 2023, however, this name has been dropped and it is called steatotic liver disease, for two reasons:

1. doctors wanted to name the disease correctly, because while in some cases fat storage in the body (obesity) can increase the risk of steatosis, there are also risk factors unrelated to weight;
2. for fairness, so that naming the disease does not offend people and give the impression that they are fat.

And since most people think that the terms lipids and fats are synonymous, let's explain their meaning.

Lipids: it's not just about fats and oils

Most of the population thinks of the term lipids people think of fats and oils. These, of course, also belong here, but the group of substances classified as lipids is not precisely delimited. It also includes some vitamins, oils and waxes. Chemically, they are esters of higher fatty acids and alcohols. They are as risky as they are irreplaceable. In the body, they perform the following roles:

• metabolising fatty acids and generating energy,
• they are involved in the formation of biological membranes,
• support the formation, breakdown and regulation of hormones,
• fight infections.

However, important participants in the body's processes can easily become enemies when so-called hyperlipidaemia or high cholesterol develops. This is not good for the body, because it is deposited in the blood vessels, clogs them up and the blood cannot then be transported to the organs in optimal quantities. Hepatologist Jennifer Robinson explains that "cholesterol ends up in the liver and if there is an excess of it in the diet (for example, in fatty meats and dairy products), the risk of liver stiffening (steatosis) increases rapidly, which in extreme cases can lead to a serious and life-threatening condition known as non-alcoholic steatohepatitis."

Read about the differences between alcoholic and non-alcoholic steatosis, each has different triggers and symptoms. Fatty liver also occurs in pregnancy, although it is not common.

2 basic types of steatosis: One is caused by excessive alcohol consumption, while the other is caused by metabolic disorders

There are 2 basic types of steatosis - alcoholic and non-alcoholic. However, there is also acute pregnancy steatosis.

Non-alcoholic steatosis can result in steatohepatitis and threaten your life

At the outset, it should be said that non-alcoholic steatosis arises as a result of metabolic disorders and an unhealthy lifestyle. Closely related to/with:

• high (LDL) cholesterol,
• obesity,
• type 2 diabetes,
• hypertension,
• excessive consumption of refined sugar,
• genetic predisposition,
• the state of the gut microbiome, which differs in patients with steatosis from that of healthy persons.

Non-alcoholic steatosis is a condition where fat accumulates in the liver of non-alcohol drinkers. "If you have fat accumulating in your liver and also have no history of alcoholism, you will most likely be diagnosed with nonalcoholic steatosis," estimate experts at the National Institute of Diabetes and Digestive and Kidney Diseases. If the fatty buildup in the liver is accompanied by prolonged inflammation, it leads to so-called nonalcoholic steatohepatitis, which, if left untreated, leads to liver fibrosis and, in severe cases, cirrhosis and liver failure.

Alcoholic steatosis is a precursor to cirrhosis and liver failure, liver cells die off in droves

Every time the liver metabolizes alcohol, the cells in it die. Usually, although it is able to replace the dead cells with new ones, if you ingest large amounts of alcohol, the liver can't keep up with you and stutters. Alcoholic steatosis occurs, which is the first stage of alcohol-induced liver damage.

There are three stages in total:

1. Fatty liver (steatosis) - fat accumulates inside the liver cells. The liver is enlarged, yellow in colour (yellow to orange when engorged) and fatty in cross-section. This is the most common problem caused by alcohol.
2. Alcoholic hepatitis - this is an acute inflammation of the liver in which liver cells die. Permanent scarring of the liver often occurs.
3. Cirrhosis - destruction of normal liver tissue occurs, leaving behind scarring in places where healthy liver tissue should be. At this stage, the liver is at risk of ceasing to function and failing.

Acute hepatic steatosis in pregnancy is uncommon, but can be distressing

A condition where excess fat accumulates in the liver during pregnancy is a rare but serious pregnancy complication. The cause is unknown, although most experts are inclined to believe that genetic predispositions are the reason. "Once acute steatosis develops, it usually occurs in the third trimester of pregnancy. Untreated steatosis poses a serious health risk to mother and child," explains hepatologist Saurabh Sethi (7). Sometimes the situation is so serious that it necessitates termination of the pregnancy before the due date. In most cases, however, the condition of the liver returns to normal a few weeks after delivery.

What are the symptoms of a fatty liver? From no symptoms to liver failure

Detecting the symptoms of a fatty liver can be difficult. Experts at Johns Hopkins Medicine have listed the most common symptoms of steatosis of the liver, which for a long time has no visible symptoms. These symptoms are:

• fat buildup enlarges the liver, causing pressure and discomfort in the right upper abdomen,
• fatigue and weakness,
• weight loss with no apparent cause.

In steatohepatitis (inflammation of the liver), the symptoms are more noticeable:

• pain in the right upper abdomen,
• fever,
• weakness,
• nausea and vomiting,
• loss of appetite,
• malnutrition,
• yellowing of the skin and eyes (jaundice).

Cirrhosis combines all the symptoms of steatohepatitis and adds the following symptoms:

• portal hypertension (increased pressure in the hepatic vessels),
• enlargement of the spleen,
• malnutrition,
• intestinal bleeding,
• fluid accumulation in the abdomen,
• renal failure,
• confusion.

What to do with a stiff liver? Diet modification, weight loss and alcohol abstinence can help

Regular liver screening increases the chances of early detection of hepatic steatosis and a complete cure. Even if you get to the early stages of cirrhosis, it is possible to reverse the course of the disease and prevent further damage to the liver by taking measures to relieve the liver. However, it is essential to first have a lipid profile (lipid metabolism test) and a general check-up of the liver, and then follow the doctor's recommendations.

1. Eliminate unhealthy foods (those containing refined sugar and excess trans-fatty acids) from your diet.
2. Embark on weight loss if you are overweight (weight loss relieves both the liver and kidneys).
3. Include fruits, vegetables, fiber, and whole grains in your diet.
4. Abstain and do not smoke.
5. Move more (regular light exercise helps blood flow to the liver).
6. Give supplements that support liver function a chance (e.g. milk thistle).

A fatty liver can be called a silent killer because it sneaks in without warning signs. Most people don't even realize that their liver is crammed with fat, which can lead to serious health problems such as cirrhosis or liver cancer. That's why regular checkups are essential. Taking care of your liver with a healthy lifestyle and regular checkups can save your life, and you may not even have a clue that you're at risk.