Fatty liver
Fatty liver means your liver stores more fat than normal. You usually notice nothing; it often shows up as a slightly raised ALT in your blood. It goes with belly fat and a body that responds less well to insulin, and it is reversible. Fatty liver is also called steatotic liver disease or MASLD.
What are the symptoms of fatty liver?
Fatty liver usually gives no complaints. It is a chance finding, for instance fat on an ultrasound made for another reason. Only when the liver becomes inflamed or forms scars can complaints follow, and even then by no means always.
A measurement explains no complaint: the reading and the diagnosis belong with your GP. The complaint list follows the Dutch GP guideline on viral hepatitis and other liver conditions (NHG) and Thuisarts.nl.
Often named, not confirmed
You will run into these links everywhere. We list them deliberately, with what the research does show.
- Tirednessnot confirmed
According to Thuisarts it only comes with an inflamed liver, not with fat itself.
- Pain in the upper right bellynot confirmed
Belongs to an inflamed liver, not to fat on its own.
How does fatty liver develop?
Fatty liver can stay silent for years. In some people it goes further.
- Fat in your liverThis gives no complaints. Your ALT may be slightly raised, but also normal.Your ALT
- The liver becomes inflamedLiver cells get damaged.
- Scarring in the liverThe FIB-4 estimates how likely that is.Your FIB-4
When is your ALT too high?
The most specific liver value. Slightly raised, up to one and a half times the upper limit, often means nothing in someone who is otherwise well.
Within range:
below 34 U/L
Enter your value as it appears on your results. Range for adults.
No value yet? How to get it measured
What do you do about fatty liver?
Lose weight
Move more
Leaving alcohol
Treating other conditions well
The advice follows the Dutch GP guideline (NHG), Thuisarts.nl and the European liver guideline.
What causes fatty liver?
Metabolism
Most common
Metabolism
Most common- Excess weight, especially around the belly
- Type 2 diabetes or insulin resistance
- An abnormal fat profile: high triglycerides, low HDL
Alcohol and substances
Alcohol and substances
- Prolonged heavy drinking, which gives an alcoholic fatty liver and is reversible after stopping
- Some medicines, which the NHG names as a cause of steatosis
Age
Age
- At 65 and over, 35% of Dutch people have fatty liver, against 15 to 30% in the whole population
How to get fatty liver measured
Every value below has its own page: what is normal, and what your value means.
| Value | What it shows | Points here when |
|---|---|---|
| ALTdefining | The most specific liver value. Slightly raised, up to one and a half times the upper limit, often means nothing in someone who is otherwise well. | high |
And 10 values that complete the picture
| Value | What it shows | Points here when |
|---|---|---|
| AST | Rises along, but also sits in muscle and heart. Its ratio to ALT helps read the cause. | high |
| Gamma-GT | Sensitive but unspecific: rises with almost any liver stimulus, alcohol and medication included. | high |
| FIB-4 | Estimates the chance of scarring from age, ALT, AST and platelets. Below 1.30 low, above 3.25 high. | high |
| Triglycerides | Where the fat comes from: a liver that sees too much insulin makes too many triglycerides. | high |
| HDL Cholesterol | Falls in the same pattern. With triglycerides, the metabolic side of the picture. | low |
| Fasting glucose | Fatty liver and insulin resistance go hand in hand; fasting glucose shows how far that has come. | high |
Also in this test
- The comprehensive test (€229, single test) measures the values on this page.
- Every draw is fasted: nothing to eat or drink from midnight, only water. Appointments are therefore in the morning, until 12:00.
- You can draw at 600+ locations near you, no referral needed. See the locations
- Results within 24 hours of analysis, in the app.
What is fatty liver?
The liver processes what you eat and drink and keeps the fat and sugar balance in order. If it structurally receives more than it can get rid of, especially with belly fat and a body that listens poorly to insulin, it stores fat in its own cells; fructose from soft drinks and fruit juice is converted directly into liver fat in the process. That is reversible in itself. In a small share of people the fatty liver becomes inflamed, and that inflammation can form scars over time: fibrosis, and in a small share of those cirrhosis. The liver does not complain. Fatty liver gives no complaints and is usually a chance finding: a slightly raised ALT in a blood test done for another reason, or fat on an ultrasound of the abdomen. ALT is the most specific liver value, gamma-GT sensitive but non-specific. Anyone who wants to read the liver therefore reads ALT, and beside it the fats and the sugar, because those tell where the fat comes from. The FIB-4 turns age, ALT, AST and platelets together into an estimate of the chance of scarring. It is common: in 15 to 30% of the population and in 35% of Dutch people aged 65 and over. The greater risk sits not in the liver but outside it: people with fatty liver have cardiovascular disease about 2 times as often and a 1.5 times higher mortality, because the same belly and the same insulin resistance also strain the vessels.
What is fatty liver confused with?
Each with the one value that tells the two apart.
Alcoholic fatty liver
The same fat on the ultrasound and the same slightly raised ALT. The distinction comes from the conversation about drinking, not from a value: gamma-GT rises in both.
Chronic hepatitis B or C
Also years of a slightly raised ALT without complaints. Only serology rules it out, and the NHG offers that test to people from countries where hepatitis is common even without complaints.
Haemochromatosis
Also a liver that suffers without you feeling it. A high ferritin with a high transferrin saturation points that way; in fatty liver, ferritin is at most slightly raised.
Frequently asked questions
Not by complaints. Fatty liver gives no complaints and is usually found by chance: a slightly raised ALT in a blood test done for another reason, or fat on an ultrasound of the abdomen. Tiredness, nausea or pain in the upper right of the abdomen only belong with a liver that becomes inflamed, and even then not in everyone. What you do see is the belly: a growing waist is the sign you have without a blood test.
Sources 3
- 1.NHG-Standaard Virushepatitis en andere leveraandoeningen. 2023. richtlijnen.nhg.org
- 2.EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD), Journal of Hepatology. 2024. doi.org
- 3.Thuisarts.nl, Ik heb een vetlever. 2023. thuisarts.nl
Was this what you were looking for?
Share
This page explains what a result means. It is not a diagnosis and not treatment advice. Discuss complaints or an abnormal value with your doctor.
Read about our scientific approach