Fatty Liver: The Report, Liver Enzymes and How It Resolves
Fatty liver is most often not felt at all. It is found by chance, on an ultrasound done for something else, or through mildly raised enzymes in the blood. That makes it easy to write off as a trifle, and it is not: it is the most common liver disease today, and blood sugar, lipids and waist circumference almost always come with it. The good news is that it is the one liver disease that can be reversed at an early stage. This article explains how the report is read, which numbers really mean something, how the presence of scarring is assessed and what specifically brings the fat in the liver down.
How fatty liver is found
| Test | What it shows |
|---|---|
| Abdominal ultrasound | The most common finding: a liver that is “brighter” than the kidney. It sees fat, it does not see scarring |
| ALT and AST | Liver enzymes; with a fatty liver usually mildly raised, and often entirely normal |
| GGT | It follows damage and is sensitive to alcohol and medicines |
| Triglycerides, HDL, blood sugar, HbA1c | They almost always come with the finding and they change the plan |
Fat is not the same as scarring
The question that decides everything is not how much fat there is but whether scarring, that is fibrosis, has started. Fat on its own does not damage the liver permanently; scarring does. That is why, after a finding of steatosis, the FIB-4 is calculated, a simple index from age, ALT, AST and the platelet count, which separates those in whom scarring is unlikely from those who need further investigation. A low FIB-4 means going on to changed habits and a check-up; a raised one means a further assessment, most often elastography.
Where it comes from
- Excess weight, especially fat around the waist, and insulin resistance.
- Type 2 diabetes and raised triglycerides.
- Alcohol, which is always assessed separately, because it changes both the diagnosis and the plan.
- Some medicines, rapid weight loss and, more rarely, inherited and hormonal causes.
Fatty liver also occurs in people who are not obese, most often alongside insulin resistance and raised triglycerides, so a normal weight does not rule the finding out.
What genuinely reduces the fat in the liver
Here the numbers do exist and are worth knowing, because they set the target:
| Weight loss | What it achieves |
|---|---|
| 3 to 5 % | The fat in the liver goes down |
| 7 to 10 % | The inflammation resolves too, the target for most people |
| over 10 % | In some people the fibrosis improves as well |
Alongside that: cutting out fizzy drinks and juices with fructose, regular physical activity even when the weight is not changing much, and a strict limit on alcohol. Losing weight abruptly is not better, because it can make the finding worse. There is no medicine that replaces these steps, and supplements for “cleansing the liver” have no proven effect.
When the finding calls for a faster work-up
Enzymes raised repeatedly and markedly, yellowing of the skin or the whites of the eyes, dark urine, swelling of the legs or the abdomen, weight loss for no reason and a raised FIB-4 are all reasons not to postpone an appointment. The same applies when a fatty liver comes together with hepatitis B or C, because scarring then develops faster.
What the appointment looks like
Bring the ultrasound report, the liver enzymes, the lipids, blood sugar and the blood count to the appointment, because the platelets go into the FIB-4. A gastroenterologist or an internist reads the results together, assesses the risk of fibrosis, rules out other causes of raised enzymes and sets a target in kilograms and a date for the next check. No referral is needed for an appointment with us.
Prices
| Service | Price |
|---|---|
| Abdominal ultrasound (Dr Uroš Miladinović) | 6.000 RSD |
| Gastroenterology appointment (Dr Stanko Petrović) | 10.000 RSD |
| Full appointment with abdominal ultrasound (Dr Stanko Petrović) | 14.000 RSD |
| Internal medicine appointment (Dr Andreja Kovačević) | 6.000 RSD |
Frequently asked questions
Does a fatty liver resolve?
Yes, at an early stage. Losing 3 to 5 % of body weight reduces the fat, and 7 to 10 % resolves the inflammation as well. In some people more than 10 % also improves early fibrosis.
Can liver enzymes be normal with a fatty liver?
They can, and most often they are. Normal ALT and AST do not rule out steatosis, which is why an ultrasound finding is not written off because of normal enzymes.
What is FIB-4 and why is it calculated?
An index from age, ALT, AST and platelets that estimates the probability of scarring in the liver. A low result means monitoring and changed habits, a raised one means a further assessment, most often elastography.
May I drink alcohol?
Alcohol and a fatty liver pull in the same direction, so the amount is strictly limited, and with signs of scarring it is avoided. How much is acceptable in your case is judged by the doctor from your results.
Do liver cleansing preparations help?
They have no proven effect on fat or on fibrosis. What does have an effect is weight loss, movement, control of blood sugar and triglycerides, and limiting alcohol.
Book an appointment
If an ultrasound has shown a fatty liver, or your enzymes are raised, book an appointment at the Miren Medic clinic. The ultrasound, the interpretation of the results and the assessment of fibrosis risk come from one place, without a referral, with a target expressed in kilograms and a deadline.
