You might feel perfectly healthy and still have a liver quietly storing too much fat. Here’s what you need to know – and the simple changes that can help. You might associate fatty liver with drinking too much alcohol.
But the reality is considerably more complicated – and increasingly relevant as we get older.
Fatty liver disease is now one of the most common liver conditions in Australia, affecting around one in three Australian adults. And research suggests the problem is even more common among people in their 60s and 70s.
A major Australian study found the prevalence of non-alcoholic fatty liver disease rose to 43 per cent among people aged 60 to 79.
Another study of almost 10,000 Australians with an average age of 75 found that 33 per cent met the criteria for metabolic dysfunction-associated steatotic liver disease (MASLD), the newer name for what was previously called non-alcoholic fatty liver disease (NAFLD).
And here’s the worrying part: you may have it without knowing it.
Fatty liver occurs when excess fat builds up in the liver.
The condition is now generally described under the broader term steatotic liver disease (SLD). The type associated with metabolic health – formerly known as NAFLD – is now called metabolic dysfunction-associated steatotic liver disease, or MASLD.
It isn’t simply a problem caused by alcohol.
MASLD is strongly associated with metabolic factors including being overweight, having a large waist circumference, high blood pressure, high cholesterol and type 2 diabetes.
And because these conditions become increasingly common as we age, our risk of fatty liver can rise too.
One of the most frustrating things about fatty liver is that it can be remarkably quiet.
Many people have no obvious symptoms, particularly in the early stages.
It may instead be discovered when you have blood tests for another reason or undergo an ultrasound or other investigation.
That’s why it can be tempting to dismiss slightly abnormal liver blood tests – or assume that feeling well means your liver must be healthy.
But fatty liver shouldn’t simply be ignored.
In some people, excess fat can trigger inflammation and liver damage. Over time, this can lead to fibrosis (scarring), cirrhosis and, in the most serious cases, liver failure or liver cancer.
There’s another reason fatty liver deserves attention after 60.
It’s increasingly viewed as a marker of metabolic health, rather than simply a disease of the liver.
The Australian Liver Foundation says fatty liver is associated with problems such as obesity, poor nutrition and physical inactivity – the same factors that contribute to conditions including heart disease and type 2 diabetes.
So discovering fatty liver can be a useful wake-up call.
It may be telling you that your body isn’t handling energy, blood sugar and fat as efficiently as it once did.
A fatty liver diagnosis isn’t necessarily a life sentence.
In many people, liver damage can be reversed, particularly when action is taken before significant scarring develops.
And the changes recommended aren’t particularly exotic.
If you’re carrying excess weight, losing weight can reduce the amount of fat stored in your liver.
You don’t necessarily need to embark on a drastic diet. Sustainable changes that gradually bring your weight down are more realistic – and easier to maintain.
Exercise is good for your liver even if the scales don’t immediately move.
Walking, cycling, swimming, gardening or strength training can all help improve your metabolic health.
The goal isn’t necessarily to become a gym junkie. It’s to spend less time sitting and more time moving.
Think about what makes up your everyday diet.
Highly processed foods, sugary drinks, sweets, cakes and foods high in saturated fat can make it easier to consume more calories than your body needs.
Instead, build meals around vegetables, fruit, wholegrains, legumes, lean proteins, fish, nuts and healthy fats.
A Mediterranean-style eating pattern is often a sensible model to follow.
Too much added sugar can contribute to weight gain and metabolic problems.
And it’s not only the obvious offenders such as lollies and soft drinks.
Watch out for sugar hidden in breakfast cereals, flavoured yoghurts, sauces, biscuits and many packaged foods.
Alcohol can certainly contribute to liver disease, but you can develop fatty liver without being a heavy drinker.
That’s particularly important because the term “fatty liver” can make people assume the condition is simply an alcohol problem.
It isn’t.
There isn’t a simple home test.
Your GP may begin with blood tests to assess liver function and your broader metabolic health. Depending on your circumstances, further investigation may include an ultrasound, FibroScan or other tests designed to assess liver fat and scarring.
And don’t be reassured simply because you feel fine.
The Liver Foundation warns that fatty liver can progress to significant liver damage without obvious symptoms.
If you’re over 60 and have several risk factors – such as excess weight around your middle, type 2 diabetes, high blood pressure, high cholesterol or a sedentary lifestyle – it’s reasonable to discuss your liver health with your doctor.
It’s particularly worth raising the subject if you’ve had abnormal liver blood tests or are concerned about your metabolic health.
And there’s a reassuring message here.
Fatty liver is common, but it doesn’t have to be inevitable – and catching it early gives you an opportunity to do something about it.
With the right lifestyle changes, the liver has a remarkable ability to repair itself.
There isn’t currently a reliable national figure showing how many Australians aged 65-plus are newly diagnosed with fatty liver each year. That’s an important data gap.
What we do know is that fatty liver is extremely common: the Australian Liver Foundation estimates about one in three Australian adults has the condition.
And Australian research has found prevalence climbing to 43 per cent among people aged 60 to 79.
In other words, if you’re in your 60s or 70s, fatty liver isn’t a rare condition affecting “other people”.
It could be something worth discussing at your next check-up.
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