⚠️ Fatty Liver: Why It Matters (and What You Can Do About It)

Fatty liver disease is one of the fastest-growing health problems in the UK. It's often silent for years, but carrying serious long-term risks. You may have heard it called non-alcoholic fatty liver disease (NAFLD), but we are now increasingly using a new term:
Metabolic dysfunction-associated steatotic liver disease (MASLD), and when inflammation and scarring are present, Metabolic dysfunction-associated steatohepatitis (MASH).

Different names, same underlying story: too much fat in the liver, usually linked with our modern lifestyles: weight gain, poor diet, inactivity, and metabolic conditions like insulin resistance, type 2 diabetes and high blood pressure.

How common is it?

Recent UK data suggest that one in three adults may have NAFLD. This high prevalence makes it one of the most common chronic liver conditions in the UK.

• In 2022, there were 323 premature deaths (under age 75) in England linked to NAFLD, a rate of 0.6 per 100,000 people.

• 3,126 people were admitted to hospital that year with a primary diagnosis of NAFLD. Nearly 6 admissions per 100,000.

• Overall, liver disease deaths have risen nearly 40% since 2001. One of the few major conditions still increasing in the UK.

• The British Liver Trust estimates that up to 80 % of people with advanced MASH are undiagnosed.

So although most people with fatty liver feel perfectly well, this is a growing public-health challenge hiding in plain sight.

Why does it matter?

When the liver stores excess fat, it can become irritated and inflamed — this is MASH (previously called NASH). Over time, this can lead to scarring (fibrosis) and eventually cirrhosis, when the liver becomes permanently damaged and struggles to function.

The more advanced the fibrosis, the higher the risk of:

• Liver failure and liver cancer

• Variceal bleeding, ascites and encephalopathy (complications of cirrhosis)

But the biggest danger actually lies outside the liver. People with fatty liver are much more likely to develop:

• Heart disease – the leading cause of death in NAFLD/MASH

• Type 2 diabetes

• Chronic kidney disease

• Certain cancers, especially bowel cancer

Fatty liver is therefore a whole-body warning sign — a marker of metabolic stress that signals higher risks across multiple organs.

How do we assess who’s at higher risk?

Because it’s not practical or necessary to biopsy everyone, specialists now use non-invasive tests (NITs) to check for scarring.

A common stepwise approach is:

1. FIB-4 score – a simple blood test using age, platelets, and liver enzymes.

   • A low score means low risk of scarring.

   • A high score (usually > 2.67) means further assessment is needed.

2. FibroScan (vibration-controlled transient elastography) – a painless ultrasound-based test that measures how “stiff” the liver is.

   • Softer = healthier.

   • Stiffer = more fibrosis.

3. Other blood or imaging tests – such as the Enhanced Liver Fibrosis (ELF) test or magnetic resonance elastography (MRE) for more detailed assessment.

These tools are now widely used in NHS liver and metabolic clinics and are making early detection far more accessible.

What can you do if you have or are at risk of fatty liver?

The encouraging news is that lifestyle change works. Even modest improvements can make a measurable difference:

• Lose 5–10 % of your body weight if overweight. This can reduce fat and scarring in the liver.

• Move more – aim for at least 150 minutes a week of moderate activity (brisk walking, cycling, swimming). If you can't do 150 minute, any movement is better than none. Aim for a sustainable habit.

• Eat a Mediterranean-style diet – rich in vegetables, fruit, whole grains, fish, and olive oil.

• Cut back on alcohol – even though MASLD isn’t caused by alcohol, it still aggravates liver damage.

• Manage blood pressure, cholesterol, and blood sugar – your liver and heart will thank you.

The bottom line

Fatty liver, whether you call it NAFLD or MASH, is increasingly common and often silent. For most people it won’t lead to serious liver disease, but for some it can progress to cirrhosis or liver cancer, and it also signals higher risk for heart and metabolic problems.

The good news is that early diagnosis and small, consistent lifestyle changes can reverse or stabilise the condition.

If you’ve been told you have a fatty liver, don’t ignore it. Think of it as a timely wake-up call to invest in your future health.