Fatty liver disease has become increasingly common, affecting roughly one-third of the population. If left undiagnosed, it can quietly progress to cirrhosis and even cancer. What are the risk factors, and how is it diagnosed and treated?
Fatty liver disease—also known as hepatic steatosis or steatotic liver disease—is a condition in which excess fat accumulates in the liver. Although early stages often present few or no symptoms, the disease can become life-threatening.
“Fatty liver is more common than any other liver disease we know,” explains Dr. Tarek Saadi, director of the Liver Disease Unit and attending physician at the Gastroenterology Institute and Liver Unit at Rambam Health Care Campus. “If more than 5% of liver cells contain fat, it’s already considered fatty liver disease. Patients don’t feel anything, so many are diagnosed late—typically through blood tests or imaging.”
Some patients may experience weakness, fatigue, or mild pain in the upper right quadrant of the abdomen. Because these symptoms are subtle, they are often ignored—allowing the disease to progress unnoticed.
Primary Risk Factors: Obesity and Diabetes
According to Saadi, the four primary risk factors are abdominal obesity, diabetes, hypertension, and elevated blood lipids. “Anyone with one or more of these factors is at risk, and patients with diabetes or a BMI over 25—and especially over 30—should be monitored.”
Diagnosis typically begins with a routine blood test, followed by an evaluation of the patient’s medical history, risk factors, and lifestyle. If liver enzyme levels are abnormal, a diagnosis is made. Imaging—usually via ultrasound—then confirms the disease or reveals an enlarged spleen, another potential indicator.
In more advanced cases, fat accumulation can trigger inflammation. This condition, referred to as MASH, short for metabolic dysfunction-associated steatohepatitis, may lead to fibrosis or liver scarring, and eventually cirrhosis. “It’s a progressive process that can take years, but timely intervention is crucial,” says Saadi.
Fibrosis is categorized into five stages: none, mild, moderate, advanced, and cirrhosis. As fibrosis worsens, complications may arise, including abdominal fluid buildup, esophageal bleeding due to enlarged veins, and altered brain function—potentially requiring a liver transplant.
“Severe cirrhosis can be fatal. The risk of liver cancer also increases, making early diagnosis essential,” Saadi warns.
Diagnosis and Treatment
A liver biopsy is no longer required to assess fibrosis. Instead, a diagnostic tool called FibroScan—similar to an ultrasound—is used to measure fat levels and fibrosis. It’s a simple, painless, and accurate test available at Rambam’s Liver Disease Unit. However, it’s not covered by the national health basket, so a small fee applies.
The most impactful treatment begins with lifestyle changes: weight loss, regular physical activity, balanced nutrition, and management of diabetes, cholesterol, and blood pressure. “In reality, weight loss and lifestyle changes are difficult to maintain, which is why we’re exploring alternative treatments,” says Saadi.
In some cases, bariatric surgery may be necessary. While weight loss injections are still not available in the health basket, but new drug therapies from the GLP-1 family—effective for both weight loss and liver health—have emerged. Semaglutide-based medications, such as Wegovy, have been FDA approved for patients with MASH and moderate to advanced fibrosis (F2–F3), excluding cirrhosis. Another drug from the GLP-1 family —Mounjaro (tripeptide) is under investigation. A recently published study found that Wegovy significantly improved both inflammation and fibrosis in MASH patients.
“Anyone who is overweight, diabetic, or has high cholesterol should consult a family doctor and undergo a thorough examination,” concludes Saadi. “If fatty liver is detected, the physician will assess inflammation and fibrosis. Sometimes lifestyle changes are enough, but if not, we have proven drug therapies that can improve the condition and prevent serious complications.”
Based on a Hebrew article that first appeared on Ynet.
