Nonalcoholic Fatty Liver Disease Johns Hopkins Medicine COVID-19 Updates Masks are required inside all of our care facilities. We are vaccinating all eligible patients. Learn more: Vaccines, Boosters & Additional Doses Testing Patient Care Visitor Guidelines Coronavirus Email Alerts Find more COVID-19 testing locations on Maryland.gov. CloseSearch Submit Search Popular Searches coronavirus careers medical records map insurance accepted telemedicine Menu Health Nonalcoholic Fatty Liver Disease Share on Facebook Share on Twitter Share on Linkedin Share on Pinterest Share via Email Print this Page Fatty liver disease means that you have fat inside your liver that can, over time, affect liver function and cause liver injury. People who drink too much alcohol may also have fat in their liver, but that condition is different from fatty liver disease. Types of fatty liver disease Health care providers divide fatty liver disease into two types. If you just have fat but no damage to your liver, the disease is called nonalcoholic fatty liver disease (NAFLD). If you have fat in your liver plus signs of inflammation and liver cell damage, the disease is called nonalcoholic steatohepatitis (NASH). About 10% to 20% of Americans have NAFLD. About 2% to 5% have NASH. Symptoms Fatty liver disease is sometimes called a silent liver disease. This is 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. If you have NASH, you may have symptoms that could take years for them to develop. If liver damage from NASH leads to permanent scarring and hardening of your 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 over time may develop liver failure and need a liver transplant. Who s at risk Health care providers don't know the exact cause of fatty liver disease. But they think that obesity is 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 Diagnosis Fatty liver disease can happen without causing any symptoms. It's usually diagnosed when you have routine blood tests to check your liver. Your health care provider may suspect fatty liver disease with abnormal test results, especially if you are obese. Imaging studies of your liver may show fat deposits. Some imaging tests, including special ultrasound and MRI scans can help diagnose the disease and spot scar tissue in the liver. But the only way to be certain that fatty liver disease is the only cause of liver damage is with a liver biopsy. A liver biopsy involves getting a tissue sample of your liver with a needle. The needle removes a small piece of liver tissue that can be looked at under a microscope. Here's how your health care provider makes the diagnosis: If you have fat but no inflammation or tissue damage, the diagnosis is NAFLD. If you have fat, inflammation, and liver damage, the diagnosis is NASH. If you have a type of scar tissue in your liver called fibrosis, you may be developing cirrhosis. Treatment If you have NAFLD without any other medical problems, you don't need any special treatment. But making some lifestyle changes can control or reverse the fat buildup in your liver. These may include: Losing weight Lowering your cholesterol and triglycerides Controlling your diabetes Avoiding alcohol If you have NASH, no medication is available to reverse the fat buildup in your liver. In some cases, the liver damage stops or even reverses itself. But in others, the disease continues to progress. If you have 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. These include antioxidants like vitamin E. Scientists are also studying some new diabetes medications for NASH that may be given even if you don't have diabetes. However, you should only take these medicines after consulting with a liver specialist. Complications The main complication of fatty liver disease is the progression of NASH to cirrhosis. Cirrhosis means permanent scarring and hardening of the liver. When to call the health care provider If you've been diagnosed with any fatty liver disease, let your health care provider know if you have any symptoms that mean the disease is getting worse. These include fatigue, loss of appetite, weight loss, weakness, fluid retention, or bleeding. Living with fatty liver disease If you are living with fatty liver disease, learn as much as you can about your condition and work closely with your medical team. Since many medications can harm your liver, always let all your health care providers know about any medications you are taking. These include OTC drugs, dietary supplements, and vitamins. Other ways to manage fatty liver disease include maintaining a healthy weight, eating a balanced diet, getting regular exercise, and continuing to avoid alcohol. Find a Doctor Specializing In: Nonalcoholic Fatty Liver Disease Hepatology At Another Johns Hopkins Member Hospital: Howard County General Hospital Sibley Memorial Hospital Suburban Hospital Find a Treatment Center Find Additional Treatment Centers at: Howard County General Hospital Sibley Memorial Hospital Suburban Hospital Related 5 Reasons You May Be at Risk for Liver Disease Detoxing Your Liver: Fact Versus Fiction Request an Appointment Find a Doctor Find a Doctor See More Related Chronic Liver Disease 5 Reasons You May Be at Risk for Liver Disease Non-alcoholic Fatty Liver Disease Detoxing Your Liver: Fact Versus Fiction