1 in 4 adults walking around has it.
Most have no idea.
I’ve been doing abdominal ultrasound scans for over two decades, and the shift I’ve seen in that time is staggering.
Twenty years ago, fatty liver was something you’d note occasionally. Now? I’m seeing it multiple times a day. Every day.
And here’s the thing—most people aren’t coming in because they’re worried about their liver. They’re coming in for something completely unrelated. Gallbladder pain. Kidney stones. Routine health checks.
Then I scan across the liver, and there it is: increased echogenicity, the texture brighter than it should be compared to the kidney. Sometimes the liver edge is rounded instead of sharp. Sometimes it’s enlarged.
“Your liver looks a bit fatty,” I’ll mention.
The response is almost always the same: confusion.
“But I don’t drink.”
“I feel fine.”
“Is that serious?”
Here’s what most people don’t realise: non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver conditions globally.
Not because of alcohol. Because of how we eat. How we move. How our metabolism has adapted—or failed to adapt—to modern life.
The numbers tell the story:
- 25-30% of the global population has NAFLD
- In people with obesity, that jumps to 70-80%
- In people with type 2 diabetes, it’s around 70%
- Most are completely asymptomatic until it’s advanced
The liver is remarkably good at its job, even when it’s struggling. You can have significant fat accumulation and feel absolutely nothing. No pain. No fatigue. Nothing.
That’s why ultrasound catches so many cases incidentally.
Fatty Liver: What I’m looking for on the scan
The normal liver has a fine, homogeneous texture—similar echogenicity to the kidney cortex. When fat starts accumulating, the liver becomes brighter (more echogenic). The vessels running through it become harder to see because the surrounding tissue is reflecting more sound. The deeper portions of the liver become harder to visualise because the sound isn’t penetrating as well.
In more advanced cases, the liver edge loses its usual sharp definition and becomes rounded. The organ may be enlarged. Sometimes you’ll see a coarse texture suggesting more significant changes.
But here’s the limitation: ultrasound can tell me there’s fat. It can’t tell me if inflammation or fibrosis is developing.
That’s the difference between simple steatosis and NASH (non-alcoholic steatohepatitis)—and it’s a difference that matters.
Simple steatosis: fat in the liver, relatively stable, reversible with lifestyle changes.
NASH: fat + inflammation + liver cell damage. This can progress to fibrosis, cirrhosis, and liver failure.
Ultrasound alone can’t make that distinction. That’s when we escalate to FibroScan, MRI, or biopsy.
NASH Fatty Liver – Why this matters
NAFLD isn’t just a liver problem. It’s a metabolic problem.
It’s strongly linked to insulin resistance, obesity, type 2 diabetes, high triglycerides, and metabolic syndrome. These aren’t separate conditions happening in parallel—they’re connected. The liver is often one of the first sites where metabolic dysfunction appears on imaging.
And while simple fatty liver might sound benign, it’s a warning sign. Left unchecked, it can progress. And in a subset of people, it progresses to serious liver disease.
The fatty liver reversal question
The good news? In the early stages, it’s reversible.
Weight loss of 7-10% of body weight has been shown to reduce liver fat and even reverse early fibrosis in some cases. Not a detox tea. Not a supplement. Just sustained, meaningful lifestyle change.
But that requires knowing you have it in the first place.
Why I’m writing this
I see the pattern emerging on the screen before the patient even knows there’s an issue. And I see the disconnect—people who are metabolically unwell but feel completely fine.
If you have obesity, type 2 diabetes, high blood pressure, or high cholesterol, and you’ve never had your liver assessed, it’s worth the conversation with your GP.
Not because fatty liver is an emergency. But because early identification means early intervention. And early intervention changes the trajectory.
The liver is forgiving—until it isn’t.
