Fatty liver: what to do when an ultrasound finds it

In short

• Fatty liver, now often called steatotic liver disease or MASLD, is a buildup of fat in the liver that usually causes no symptoms.
• The fat itself is less worrying than the inflammation and scarring it can lead to in some people.
• Ultrasound can show fat but not inflammation or scarring, so your clinician may use blood-based scores or an elastography scan to check for scarring.
• Losing 3% to 5% of body weight can reduce liver fat, and up to 7% to 10% may be needed to reduce inflammation and scarring.
• No medicines are approved for it, and some herbal products can themselves harm the liver.

The stages, from fat to cirrhosis

1. Fatty liver.Fat builds up without damage to the liver. Most people never get past this stage.
2. MASH (previously NASH).The fat causes inflammation. The liver is not seriously damaged yet, but it could worsen.
3. Fibrosis.Scarring has started. The liver usually still works well, so preventing further damage is the priority.
4. Cirrhosis.Severe scarring affects how the liver works and can lead to serious complications, including internal bleeding, liver failure and liver cancer.

That is why the useful question after an ultrasound is not just whether there is fat. It is whether there is any sign of scarring.

Symptoms: usually none

Fatty liver is usually silent, and many people find out while being tested for something else. Some people feel very tired, generally unwell, or notice discomfort in the upper right part of the abdomen, under the ribs. Because there is so little to feel, how you feel is not a guide to how your liver is doing.

Who is at risk

• being overweight or obese, especially with fat around the waist;
• type 2 diabetes or prediabetes, or metabolic syndrome;
• high cholesterol or high triglycerides;
• high blood pressure;
• polycystic ovary syndrome;
• being middle-aged or older;
• certain medicines, rapid weight loss and hepatitis C, which MedlinePlus lists as additional risks.

Heavy drinking causes a separate, alcohol-related type of fatty liver, which is why your clinician will ask about alcohol.

How a doctor checks your liver

1. History and exam.Your clinician asks about diet, activity, alcohol and medicines, and checks your weight, height and waist.
2. Blood tests.Raised liver enzymes (ALT and AST) can suggest fatty liver. Scores such as FIB-4 or APRI, calculated from routine results, can help rule advanced scarring in or out. Other tests look for different causes of liver trouble.
3. Imaging.Ultrasound, CT and MRI can show fat in the liver, but they cannot show inflammation or fibrosis. Elastography, which can be ultrasound-based or MRI-based, measures liver stiffness, which may point to scarring.
4. Biopsy.A liver biopsy is the only test that can confirm MASH and its severity. It is not recommended for everyone and is used when advanced disease is likely or other tests are unclear.

What weight loss does for the liver

Weight loss is the main treatment. According to the NIDDK, losing 3% to 5% of body weight can reduce liver fat, and reducing inflammation and scarring may take 7% to 10%. For someone who weighs 200 pounds, that is roughly 6 to 10 pounds for the first step.

Go gradually. The NIDDK warns that rapid weight loss and malnutrition can make liver disease worse. Physical activity helps even when the scale does not move.

Everyday steps that help

• Eat a balanced diet with more fruits, vegetables and whole grains and less salt and sugar.
• Aim for at least 150 minutes of exercise a week, as the NHS advises.
• Keep alcohol within recommended limits, and ask your clinician what is right for you.
• Do not smoke.
• Work with your clinician on blood pressure, blood sugar and cholesterol, because they are part of the same picture.
• Ask your clinician about vaccines, since chronic liver disease raises the risk of some infections.

Treatment options in general terms

Lifestyle change is the foundation. No medicines are currently approved for fatty liver or MASH, although researchers are studying some. If tests show scarring, the NHS says you will be referred to a liver specialist, who may consider medicines used in specific cases. If obesity is the driver, a specialist may suggest weight-loss medicines or surgery.

Your clinician may review your other medicines, since some can contribute to liver fat. Never stop a prescribed medicine without medical advice. Check before you take any supplement, vitamin or herbal remedy: the NIDDK and MedlinePlus both note that some herbal products can damage the liver.

When to see a doctor, and red flags

See your primary care provider if you have risk factors and have never had your liver checked, if liver tests stay abnormal, or if you have discomfort under your right ribs. If you already have scarring, expect regular check-ups. The NHS suggests at least once a year, with tests every 2 to 3 years.

Seek care quickly for yellow skin or eyes, a swollen belly, legs or ankles, or trouble breathing. Call 911 if you vomit blood, your stool is very dark or black, or you suddenly become confused or slur your speech.

Questions and answers

Sources

1. NIDDK — Definition & Facts of NAFLD & NASH
2. NIDDK — Diagnosis of NAFLD & NASH
3. NIDDK — Treatment for NAFLD & NASH
4. NHS — Non-alcoholic fatty liver disease (NAFLD)
5. NHS — Cirrhosis
6. MedlinePlus — Fatty Liver Disease

Sources checked on 29 October 2026.