Hepatic Steatosis (Fatty Liver)

According to the WHO, liver disease is the 10th most common cause of deaths in India. Gone are the days when liver disease was only associated with the consumption of alcohol (1).

By: Pallavi Vathiar. Practicing Clinical Nutritionist, Mumbai.

Email: fihealthie@gmail.com

Fatty Liver Disease

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition as the name itself suggests in which fat builds up in your liver.

There are two main types:

– Alcoholic fatty liver disease also known as alcoholic steatohepatitis.

– Nonalcoholic fatty liver disease (NAFLD) (2).

Alcoholic Fatty Liver

The liver is very resilient and capable of regenerating itself and has the ability to develop new cells.

Your liver filters out most of the alcohol and flushes it out of the body. But the process of breaking it down can generate harmful substances which can damage liver cells, promote inflammation, and weaken your body’s natural defenses (2).

Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD (Alcohol-related liver disease) (3)

The next stages are alcoholic hepatitis and cirrhosis. The risk is higher for heavy drinkers who are women, have obesity, or have certain genetic mutations.

Non-Alcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) is emerging as an important cause of liver disease in India. Epidemiological studies suggest prevalence of NAFLD in around 9% to 32% of general population in India with higher prevalence in those with overweight or obesity and those with diabetes or prediabetes (4).

It is most commonly diagnosed which is not related to alcohol use but are diagnosed in those who are obese or sedentary and those who eat a highly processed diet. There are two kinds:

Simple Fatty Liver is in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.

Non-Alcoholic Steatohepatitis (NASH) is a condition in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer (2).

Who Is At Risk?

It is more common in people with_

  • Diabetes.
  • Obesity or Rapid weight reduction (middle aged or older).
  • High levels Cholesterols, Triglycerides and Blood Pressure.
  • Metabolic disorders.
  • Infections such as Hepatitis C.
  • Genetic inheritance.

Symptoms of Fatty Liver

A fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons.

NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience fatigue, weight loss, abdominal discomfort, weakness and confusion (5).

Few Studies:

Nonalcoholic Steatohepatitis (NASH) is associated with overweight and insulin resistance.

Aerobic exercise is known to reduce insulin resistance. A study on Effect of exercise and dietary modification on serum amino-transferase levels in patients with nonalcoholic steatohepatitis found that patients having high BMI suffering with central obesity who complied regularly with the exercise program, serum amino-transferase normalized and the values declined from 70.5 and to 63.2. They lost 3.1 kg weight and showed a decline in BMI and Waist Circumference. 

Serum ALT did not normalize in any of the 15 patients who failed to comply with the exercise program (6).

Non-alcoholic fatty liver disease is high in overweight adolescents in India.

In a cross sectional study it was been found that among 218 overweight adolescents aged 10 to 16 yr and their parents. NAFLD was seen in 62.5 per cent of the adolescents. BMI and waist circumference, Body Fat per cent, blood pressure (BP), ALT, AST, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher in the adolescents with NAFLD.

Hence, NAFLD was noted among nearly two-thirds of the overweight adolescents (7).

Non-alcoholic fatty liver disease associated with Hepatocellular Carcinoma (HCC): An increasing concern.

In a review article, it is been mentioned that Hepatocellular carcinoma (HCC) is the sixth most common cancer in world and third largest cause of cancer-related deaths. The last few decades have witnessed the emergence of non-viral causes of HCC, the most important being non-alcoholic fatty liver disease (NAFLD).

About 3-15 per cent of the obese patients with NASH progress to cirrhosis and about 4-27 per cent of NASH with cirrhosis patients transform to HCC. Yearly cumulative incidence of NASH-related HCC is low (2.6%) compared to four per cent of viral-HCC. NAFLD has been associated with risk factors such as metabolic syndrome, insulin resistance, altered gut flora and persistent inflammation (8).

Lifestyle Changes For Fatty Liver Disease.

  • Weight loss
  • Control Diabetes and triglycerides through diet, medication or both.
  • Avoid alcohol.
  • Eat a balanced diet.
  • Increase your physical activity.
  • Get regular check-ups from a doctor who specializes in liver care.
  • Talk with your health expert before consuming dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Treating Fatty Liver Disease with Food

Foods To Include:

  • High-fiber plants like legumes and whole grains.
  • Lots of fruits and vegetables
  • Greens, Tofu, Fish, Oatmeal, Walnuts, Avocado, Sunflower seeds, Olive oil, Green tea, Garlic, Milk and low fat milk products

Foods To Avoid:

  • Alcohol, Added sugar, Fried foods, Salt, White bread, Rice, Pasta, Red meat, etc.


  1. https://indianexpress.com/article/lifestyle/health/5-natural-ways-to-fight-non-alcoholic-fatty-liver-disease-5153056/
  2. https://medlineplus.gov/fattyliverdisease.html
  3. https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/
  4. https://pubmed.ncbi.nlm.nih.gov/21191681/#:~:text=Nonalcoholic%20fatty%20liver%20disease%20(NAFLD,those%20with%20diabetes%20or%20prediabetes.
  5. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/liver-fatty-liver-disease
  6. https://pubmed.ncbi.nlm.nih.gov/16706832/
  7. http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2018;volume=148;issue=3;spage=291;epage=301;aulast=Jain
  8. http://www.ijmr.org.in/article.asp?issn=0971-5916%3Byear%3D2019%3Bvolume%3D149%3Bissue%3D1%3Bspage%3D9%3Bepage%3D17%3Baulast%3DDhamija

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