Fatty liver disease: causes, tests and lifestyle changes

Many people in Bangladesh first hear the words “fatty liver” when an ultrasound report comes back after a routine check-up. It can sound alarming. In most cases it is an early warning that you can do something about. This article explains what fatty liver is, why it happens, how doctors check it, and what changes help.

What is fatty liver disease?

A small amount of fat in the liver is normal. Fatty liver disease means too much fat has built up in the liver. Doctors also call it steatotic liver disease (“steatosis” means fat build-up).

There are two main types:

MASLD (metabolic dysfunction-associated steatotic liver disease). This used to be called non-alcoholic fatty liver disease, or NAFLD. It is linked to being overweight, type 2 diabetes, high blood pressure and high cholesterol. It is not caused by heavy drinking.
Alcohol-related liver disease, which is caused by regularly drinking too much alcohol.

MASLD itself comes in two forms. In simple fatty liver there is fat but little or no inflammation (swelling and irritation). This form usually does not go on to cause serious damage. In MASH (metabolic dysfunction-associated steatohepatitis, formerly called NASH) the fat comes with inflammation. Over time this can cause fibrosis (scarring). Severe scarring is called cirrhosis, and it can lead to serious problems including internal bleeding, liver failure or liver cancer.

How common is it in Bangladesh?

Fatty liver is very common here. A study in urban and rural areas of Bangladesh ran ultrasound scans on 2,782 adults between December 2015 and January 2017. It found fatty liver not caused by alcohol in about one in three people (33.86%). Rates were much higher in people with diabetes (about 71%) and high blood pressure (about 63%). Women in rural areas and adults aged 45 to 54 had the highest rates. These figures are from data collected in 2015 to 2017, so the picture today may be different.

What causes it, and who is at risk?

According to the US National Library of Medicine (MedlinePlus), you are more likely to get MASLD if you:

are overweight. The more overweight you are, the higher the risk
have type 2 diabetes or prediabetes (blood sugar higher than normal but not yet diabetes)
have high blood pressure, high cholesterol or high triglycerides (a type of blood fat)
eat a poor diet or do not get enough exercise

In the Bangladesh study above, middle-aged adults had the highest rates. Children can get it too.

Less common causes include some medicines (for example, some cancer medicines), losing weight very fast, gastric bypass surgery and bowel disease. Some people get MASLD with no known risk factor. Drinking a lot of alcohol causes alcohol-related liver disease, and people with fatty liver are advised to avoid alcohol.

Symptoms

Most people with fatty liver have no symptoms at all. It is usually found when blood tests or scans are done for some other reason. Some people feel very tired or generally unwell, or have mild pain on the upper right side of the tummy.

Having no symptoms does not mean the liver is fine. Scarring, even cirrhosis, can develop over many years without symptoms. This is why follow-up tests matter, even if you feel well.

Tests doctors use

Your doctor will ask about your symptoms and how much alcohol you drink. They will check your weight, height and waist size. Tests may include:

Test	What it shows
Blood tests (liver function tests)	Signs of liver problems, and help to rule out other causes of liver disease
Fibrosis scores (for example FIB-4)	A score worked out from routine blood results to help find or rule out advanced scarring
Ultrasound scan	Fat in the liver. Other tests are needed to check for scarring
Elastography	A special scan that measures how stiff the liver is. A stiffer liver may be a sign of scarring
Liver biopsy	A small piece of liver is taken and checked under a microscope. It is the only test that can prove MASH and show clearly how severe it is. It is not recommended for everyone, only in some cases

Because fatty liver is linked to other health problems, your doctor may also check for conditions such as diabetes and high cholesterol.

Treatment and lifestyle changes

For most people, the main treatment is weight loss and a healthier lifestyle. According to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

If you are overweight, losing at least 3% to 5% of your body weight can reduce fat in the liver.
You may need to lose up to 7% to 10% to reduce inflammation and scarring.
Healthy food choices, smaller portion sizes and physical activity all help.
Being physically active helps, even if you do not lose weight.
Lose weight gradually. Losing weight fast or not eating enough can make liver disease worse.

Practical steps for daily life:

Watch portion sizes and make healthy food choices.
Move more. The World Health Organization recommends that adults get at least 150 minutes of moderate activity a week. That is about 30 minutes on five days.
Avoid alcohol. With alcohol-related fatty liver, the liver can usually recover if you stop drinking.
Ask about vaccines. People with long-term liver disease are more likely to get infections. Your doctor may recommend vaccines such as hepatitis A and B, flu and pneumococcal vaccines.

Only a doctor can decide whether you need medicine, based on your tests and your other health conditions. Do not stop or change any medicine you already take without talking to your doctor first. Some medicines can add to fat in the liver, and only the prescribing doctor should decide whether to change them.

Warning signs: get urgent medical care

These signs can mean serious liver damage. Go to a hospital emergency department straight away if you or a family member has:

vomiting blood, or vomit that looks like coffee grounds
black, sticky or tarry stools
sudden confusion, slurred speech, extreme sleepiness or difficulty staying awake
tummy pain, or difficulty breathing
a swollen tummy with fever, feeling sick or vomiting

Get an urgent doctor’s appointment if you notice:

yellow skin or yellow whites of the eyes (jaundice)
swollen legs, ankles or feet
bruising or bleeding easily
dark urine, pale stools or itchy skin
losing weight without trying, or loss of appetite

If you are not sure what to do, you can call the government health call centre Shasthyo Batayon on 16263. Doctors there give health advice by phone, 24 hours a day.

Which doctor should I see?

Medicine specialist or general practitioner: a good first step if fatty liver was found on a routine scan. They can arrange blood tests, work out your risk of scarring, and check for diabetes and other linked conditions.
Hepatologist (liver specialist) or gastroenterologist (specialist in the digestive system and liver): see one if tests suggest inflammation or scarring, if your liver tests stay abnormal, or if you have any of the warning signs above.
Endocrinologist (diabetes and hormone specialist): helpful if you have diabetes that is hard to control.
Dietitian or nutritionist: can help you make a realistic eating plan for slow, steady weight loss.
For children, start with a paediatrician, who may refer the child to a paediatric gastroenterologist.

The key message

Fatty liver is common in Bangladesh and usually causes no symptoms. Found early, it can often be improved with gradual weight loss, healthy eating, regular activity and no alcohol. Ask your doctor whether you need tests for liver scarring, and get urgent help if any warning signs appear.

This article is general information. It does not replace advice from a doctor who knows your health.

Find a doctor

Browse Liver Diseases doctors in Bangladesh on ratings.com.bd, with chambers and, where listed, visiting hours and phone numbers.

Sources

This article is general information, not medical advice. It was written by AI from the sources above. It did not pass the automatic check, and an administrator chose to publish it; no doctor or editor has reviewed it. For a diagnosis or treatment, see a registered doctor.