Fatty Liver Disease

A person with fatty liver disease has fat deposits inside their liver. These deposits may keep their liver from doing a good job of removing toxins from their blood. People who drink too much alcohol may also have fat in their liver. But that’s not the same as fatty liver disease.

There are two types of fatty liver disease. Those who have fat but no damage to their liver have nonalcoholic fatty liver disease (NAFLD). Those who have fat in their liver, plus signs of inflammation and liver cell damage, have nonalcoholic steatohepatitis (NASH). About 10-20 percent of Americans have NAFLD. About 2-5 percent of Americans have NASH.

What are the symptoms of fatty liver disease?

Fatty liver disease is sometimes called a silent liver disease because it can happen without causing any symptoms. Most people with NAFLD live with fat in their liver without developing liver damage. A few people who have fat in their liver develop NASH.

Children, adolescents and young adults with NASH may have symptoms. If liver damage from NASH leads to permanent scarring and hardening of the liver, this is called cirrhosis.

Symptoms from NASH may include:

  • Severe tiredness
  • Weakness
  • Weight loss
  • Yellowing of the skin or eyes
  • Spiderlike blood vessels on the skin
  • Long-lasting itching.

NASH that turns into cirrhosis could cause symptoms like fluid retention, internal bleeding, muscle wasting and confusion. People with cirrhosis may develop liver failure and need a liver transplant. Learn more about cirrhosis.

Who is at risk for fatty liver disease?

The exact cause of fatty liver disease is not known, but obesity appears to be the most common cause. Obesity in the U.S. has doubled in the last decade, and health care providers are seeing a steady rise in fatty liver disease. Although children and young adults can get fatty liver disease, it is most common in middle age.

Risk factors include:

  • Being overweight
  • Having high blood fat levels, either triglycerides or LDL (“bad”) cholesterol
  • Having diabetes or prediabetes
  • Having high blood pressure.

How is fatty liver disease diagnosed?

Fatty liver disease can happen without causing any symptoms. It’s usually diagnosed during routine blood tests to check the health and function of the liver. Your child’s doctor may suspect fatty liver disease with abnormal test results, especially if the child is obese. Drinking too much alcohol and having an infection, as well as other causes, may cause liver tests to be abnormal.

Imaging studies of the liver may show fat deposits, but the only way to diagnose fatty liver disease is with a liver biopsy. A liver biopsy involves putting a long needle through the child’s skin into the liver. The needle removes a small piece of liver tissue that can be looked at under a microscope.

  • If the tissue has fat but no inflammation or damage, the diagnosis is NAFLD.
  • If the tissue has fat, inflammation and liver damage, the diagnosis is NASH.
  • If the tissue has a type of scar tissue called fibrosis, the child may be developing cirrhosis.

Learn more about liver biopsy.

What is the treatment for fatty liver disease?

Children, adolescents and young adults who have NAFLD without any other medical problems, may not need any special treatment. Making lifestyle changes can control or reverse the fat buildup in the child’s liver. These may include:

  • Losing weight
  • Lowering cholesterol and triglycerides
  • Controlling diabetes
  • Using medication, such as over-the-counter (OTC) drugs
  • Avoiding alcohol.

If your child has NASH, no medication is available to reverse the fat buildup in their liver. In some cases, the liver damage stops or even reverses itself. But in others, the disease continues to progress. If your child has NASH, it’s important to control any conditions that may contribute to fatty liver disease. Treatments and lifestyle changes may include:

  • Losing weight
  • Medication to reduce cholesterol or triglycerides
  • Medication to reduce blood pressure
  • Medication to control diabetes
  • Limiting OTC drugs
  • Avoiding alcohol
  • Seeing a liver specialist.

Some medications are being studied as possible treatments for NASH including antioxidants like vitamin E. Scientists are also studying some new diabetes medications for NASH that may be given even if the child doesn’t have diabetes.

Why is fatty liver disease a concern?

The main complication of fatty liver disease is the progression of NASH to cirrhosis. Cirrhosis means permanent scarring and hardening of the liver.

If your child has been diagnosed with any fatty liver disease, it is important to

  • Contact your child’s doctor if their symptoms get worse. These symptoms include fatigue, loss of appetite, weight loss, weakness, fluid retention or bleeding.
  • Learn as much as possible about the condition and work closely with your child’s medical team.
  • Always tell all your child’s health care providers about any medications they are taking. These include OTC drugs, dietary supplements and vitamins.
  • Follow directions for improving the disease. Fatty liver disease may be managed by maintaining a healthy weight, eating a balanced diet, getting regular exercise and continuing to avoid alcohol.

Healthy Lifestyles for a Healthier Tomorrow

Sometimes improving a child’s nutrition and physical activity habits can reverse the effects of fatty liver disease. If your child is overweight or obese, has high cholesterol or has a high body mass index (BMI), ask your child’s doctor for a referral to one of CHOC Children’s healthy lifestyle programs. Our programs offer interactive activities for the entire family to make changes to their health.

Learn more about our healthy lifestyle classes.