Fatty Liver (Steatosis hepatis)

Fatty liver (steatosis hepatis) describes an excessive accumulation of fat in the liver cells (hepatocytes), often triggered by overeating, alcohol consumption, or metabolic disorders. It becomes dangerous if left untreated, as it can lead to inflammation, liver fibrosis, or even cirrhosis of the liver.

If the fatty liver is caused by excessive alcohol consumption, this form is referred to as alcohol-related fatty liver disease (ALD). If the fatty liver is caused by another reason, it is referred to as non-alcoholic fatty liver disease (NAFLD).

Fatty liver disease can progress through various stages, from harmless amounts of fat deposits to dangerous liver cirrhosis. Early diagnosis and treatment of the causes are crucial for the long term prognosis of the disease. The development of the stages illustrates how untreated fatty liver can lead to liver cirrhosis.

In the first phase, fat is increasingly deposited in the liver cells without inflammation. Liver function is not yet severely restricted at this stage, and the disease often remains unnoticed – and asymptomatic.
Through lifestyle changes, fatty liver can often be easily reversed at this stage.

In this phase, an inflammatory reaction develops in the liver. The fat deposits damage the liver cells and lead to chronic inflammation. This inflammation increases the risk of fibrosis ( a process of formation of scar tissue instead of healthy liver tissue), which can worsen the outcome of the disease. Symptoms such as fatigue, upper abdominal pain, and liver enlargement (hepatomegaly) may occur.

In about 10% of cases, untreated fatty liver leads to liver cirrhosis. This stage is characterized by the progressive transformation of liver tissue into non-functional scar tissue. The liver increasingly loses its ability to function, which can lead to complications such as ascites, jaundice (a yellowish discoloration of the skin and the white part of the eyes), and liver failure.

Alcoholic steatosis hepatis is the main cause of liver cirrhosis.
In 10-30% of those affected with non-alcoholic fatty liver disease (NAFLD) or the more severe form, called nonalcoholic steatohepatitis (NASH), the disease can also lead to cirrhosis.

Due to disturbed fat metabolism in the liver, fat accumulates in the liver cells (hepatocytes). This can have a variety of causes: In addition to alcoholic fatty liver (AFL) which is caused by excessive alcohol consumption, other causes can also cause a so-called non-alcoholic fatty liver (NAFLD). These include metabolic diseases, unhealthy diet, and genetic factors. Since untreated fatty liver can lead to serious liver damage, it is important to identify the causes early and take appropriate measures.

The most common cause of fatty liver is excessive alcohol consumption. The breakdown of alcohol puts a heavy strain on the liver and promotes the excessive deposition of fat in the liver cells. Long-term, alcohol-induced fatty liver can progress to alcoholic steatohepatitis (ASH) and significantly increase the risk of liver cirrhosis.

Being overweight and especially obese promotes the development of non-alcoholic fatty liver disease (NAFLD). Excess fat is stored not only in fatty tissue but also in the liver.
Obesity is often associated with other metabolic diseases – such as insulin resistance and type 2 diabetes mellitus – which additionally increase the risk of fatty liver.

Insulin resistance causes body cells to become less sensitive to insulin. This can lead to permanently elevated blood sugar levels and increased fat deposition in the liver. People with obesity, diabetes mellitus, or impaired glucose tolerance therefore have an increased risk of fatty liver.

A high-calorie diet with a high proportion of sugar, saturated fats, and highly processed foods can promote fat deposition in the liver. Fructose in particular (e.g., in soft drinks) can contribute to the development of fatty liver. In addition, an unhealthy and unbalanced diet favors diseases such as obesity and type 2 diabetes mellitus, which can also lead to the development of fatty liver.

A deficiency of essential nutrients such as vitamin E, choline, and omega-3 fatty acids can impair the liver’s fat metabolism. This can promote the development of fatty liver or accelerate its progression. Nutrient deficiencies are very often a side effect of alcohol abuse.
A balanced diet therefore also plays an important role in prevention, so as not to promote fatty liver.

Elevated triglyceride and cholesterol levels in the blood are directly related to fatty liver. Excess fats that are not stored in the body cells enter the liver and accumulate there.
This can occur due to alcohol abuse, obesity, diabetes mellitus, and also familial metabolic diseases such as hypercholesterolemia.

High blood pressure is closely related to metabolic syndrome, which also accelerates the development of fatty liver. Permanent high blood pressure can impair liver function and increase the risk of liver fibrosis.
Metabolic syndrome is a combination of obesity, high blood pressure, insulin resistance, and elevated blood lipid levels. It is considered one of the main causes of non-alcoholic fatty liver.

The liver is considered the central detoxification organ of the body. This means that the liver filters harmful substances from the blood and breaks them down. These harmful substances can be absorbed from the environment (e.g., heavy metals, pesticides) or through food (e.g., alcohol, drugs, food additives, contaminated food). Medications, tobacco smoke, and fine dust are also considered harmful substances that the liver tries to break down.
An increased toxin load leads to oxidative stress and advances inflammatory processes – this directly attacks the liver cells. This can lead to an overload of the detoxification function and consequently to a higher deposit of fat in the liver cells.

Certain medications can impair the liver’s fat metabolism and thus cause drug-induced fatty liver. These include medications such as corticosteroids, cytostatics, and some antidepressants.
The prolonged or excessive use of painkillers (e.g., paracetamol), antibiotics, or chemotherapeutic agents can also stress the liver and thus increase the risk of developing fatty liver.

Genetic disorders such as dyslipidemias, Gilbert’s syndrome, or hemochromatosis can influence the liver’s fat metabolism and thus promote the development of fatty liver.
Gilbert’s syndrome is generally considered harmless, but can lead to increased susceptibility to damage by stress factors such as obesity or toxins – this includes increased susceptibility to the development of fatty liver.
In hemochromatosis, there is a genetically determined overload of the body with iron. This is deposited in the liver and causes damage to the liver cells. This increases the risk of developing fatty liver.

Fatty liver usually progresses without symptoms in the early stages and is therefore often discovered by chance during an ultrasound examination or blood test.
Symptoms only appear in an advanced stage of the disease: when an inflammatory reaction develops (stage 2) or severe liver damage such as liver cirrhosis (stage 3).

The first stage is usually asymptomatic. In advanced stages, symptoms such as a feeling of fullness or pressure in the right upper abdomen (liver area), bloating, and reduced physical and mental performance may occur.

In non-alcoholic steatohepatitis (NASH) and alcohol-related fatty liver inflammation, obvious symptoms appear for the first time. This stage is also referred to as steatohepatitis.
Symptoms of steatohepatitis:

In the final stage of the disease, there are significant functional limitations due to severe scarring (fibrosis) of the liver. This eventually leads to serious symptoms:

Fatty liver is usually discovered and diagnosed by chance, as it usually progresses without symptoms in the early stages. In the course of routine examinations, it is then noticed, for example, through abnormal liver enzymes in ones’ blood work or during a routine ultrasound examination.
For determining the severity and initiating the right therapy, an exact diagnosis is necessary.

The liver enzymes in the blood test can well reflect the condition of the liver.
SGOT (also AST) and GPT (also ALT) are the liver enzymes and can indicate liver cell damage. While SGOT is also found in other organs, GPT is liver-specific. Therefore, it is considered a good marker for the condition of the liver.
Gamma-GT (short GGT) stands for gamma-glutamyltransferase. It is also found in other organ systems, but has the highest expression in the liver.
In existing fatty liver, these three enzymes can be increased in the blood work.

Imaging procedures such as ultrasound, MRI, CT, and MRE can also be used to diagnose fatty liver.
Fatty liver is often diagnosed during a routine ultrasound examination. The liver appears bright and enlarged. This is sufficient for a diagnosis.
Excess fat deposits within the liver can also be detected using computed tomography (CT) or magnetic resonance imaging (MRI).
Magnetic resonance elastography (MRE) is used to determine whether scar tissue or liver cirrhosis is present.

Liver biopsy is the most definitive test among diagnostic procedures, but also the only invasive one. During the biopsy, liver tissue is removed and subsequently examined microscopically. With the help of the biopsy, it can be precisely assessed whether fatty liver is present, what the underlying cause is, and how serious the liver damage is.

The goal of treatment is to relieve the liver by correcting or controlling the cause. Fatty liver is generally reversible – as long as fibrosis has not already occurred.
The form of treatment naturally depends on the underlying cause.

If the cause of the fatty liver is a specific medication, it should be medically clarified whether it is possible to replace the medication with another or even discontinue it. In any case, this must be discussed with a medical professional.
These medications include, for example, corticosteroids, some chemotherapeutic agents, or an increased intake of painkillers (e.g., paracetamol).

A balanced diet and the reduction of obesity play a major role in the treatment of fatty liver. Through an adapted diet, the process of “liver defatting” can be accelerated and the symptoms reduced.
Obesity, familial hypercholesterolemia, type 2 diabetes mellitus, and excessive alcohol consumption are just a few examples of causes of fatty liver where lifestyle changes are essential for its treatment.
Through reduced calorie intake, body weight and thus fat deposits within the liver can be reduced.
In addition, highly processed foods, refined sugar, trans fats, and too many carbohydrates should be avoided. Instead, foods such as fruits, vegetables, healthy fats (e.g., nuts), whole grain products, and proteins (e.g., fish and poultry) should be included in the diet plan.

If excessive alcohol consumption is the underlying cause of the existing fatty liver, stopping alcohol consumption is the most important therapeutic approach. Since alcohol leads to damage and consequently to fatty degeneration of the liver cells, the liver cannot regenerate with ongoing alcohol consumption. Stopping alcohol consumption abruptly, after prolonged drinking can lead to serious withdrawal symptoms, which could even result in death. Therefore it is absolutely necessary to consult a medical professional beforehand.

Untreated diabetes mellitus and elevated triglyceride levels in the blood accelerate the deposition of fat in the liver.
The triglycerides in the blood can be elevated due to diabetes mellitus or due to other metabolic diseases. These need to be lowered by adjusting the diet and, if required, medicinally, in order to break down the excessive deposition of fat in the liver.

The liver plays a central role in detoxifying the body, but can be heavily burdened by alcohol, an unhealthy diet, environmental toxins, or some medications. Excessive stress on the liver can restrict its function and lead to damage in the long term. To detoxify the liver, a balanced diet, abstaining from alcohol and nicotine, adequate fluid intake, and regular exercise help. Reducing environmental toxins and a healthy intestinal flora also contribute to supporting proper liver function. Professional detoxification measures with an expert can further support liver detoxification. These include, for example, chelation therapy or INUSpheresis.

The gut-liver axis plays a crucial role in the development and course of non-alcoholic fatty liver disease (NAFLD). A disturbed gut microbiome can weaken the intestinal barrier, allowing bacterial toxins to enter the liver and activate inflammatory reactions and increase fat deposits in the liver cells. Studies show that targeted intestinal cleansing through probiotics, prebiotics, and a fiber-rich diet can stabilize the intestinal flora, reduce inflammation, and improve liver function. These measures can positively influence the development of fatty liver, and the progression of the disease may possibly be prevented. A healthy intestinal flora thus contributes significantly to the detoxification of the liver and supports its regeneration.

Untreated, fatty liver can carry serious complications. A common consequence is the enlargement of the liver – hepatomegaly. This can be accompanied by a feeling of pressure in the right upper abdomen.
With early diagnosis and treatment, the prognosis is generally positive and the disease is reversible.

In advanced stages, inflammation of the liver can develop, which significantly increases the risk of liver cirrhosis.

Liver cirrhosis is a possible consequence of a long-standing, untreated fatty liver. Especially the fatty liver caused by strong alcohol abuse carries an increased risk of developing liver cirrhosis. In rare cases, non-alcoholic fatty liver can also develop into liver cirrhosis.
Typical symptoms:

In rare cases, acute pregnancy fatty liver can develop during pregnancy. This usually occurs in the third trimester and can be dangerous for both the mother and the child.
Early diagnosis and treatment are therefore essential. The causes for this are not yet fully understood, but genetic and biochemical fatty acid metabolism disorders of the liver play a decisive role. With early diagnosis, the prognosis is usually good.
Symptoms inlcude jaundice (Hyperbilirubinemia), nausea, and fatigue.

Fatty liver (steatosis hepatis) is a serious disease that, although often initially overlooked, can lead to severe consequences. To give you a better understanding, we have compiled and answered the most common questions about it.

The information listed contains relevant topics and serves to improve understanding.