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Fatty Liver: What It Is and Why It’s Becoming So Common?

                                                                                                                                 Ankitashree

Fatty liver, also called steatosis is a condition that arises when excess fats gets accumulated in the liver. The body does produce fats but <5-10% fats is considered fatty liver.

NAFLD affects about 25–30% of the global population.

In India, the prevalence is estimated between 9% and 32%, depending on region and lifestyle.

NASH may affect 1.5–6.5% of the global population, but numbers are rising rapidly.

Types of Fatty Liver:

  1. Alcoholic Fatty Liver Disease (AFLD): Caused by excessive alcohol consumption.
  2. Non-Alcoholic Fatty Liver Disease (NAFLD): Occurs in individuals who consume little or no alcohol.
    • Simple NAFLD (Steatosis): Fat accumulation without inflammation or liver damage.
    • Non-Alcoholic Steatohepatitis (NASH): Fat accumulation along with inflammation and damage — can progress to cirrhosis or liver cancer.

      AFLD: How Alcohol Causes Fatty Liver (AFLD):

  1. Upon consumption of alcohol, liver tries to process and degrade inorder to protect the body. Inorder to do so the liver used enzymes like- ADH and ALDH.

       Here:

      Alcohol(Ethanol) is broken down into acetaldehyde by ADH(alcohol dehydrogenase)

      Acetaldehyde is broken into acetate into ALDH(aldehyde dehydrogenase)

     This process creates a chemical called NADH(Nicotinamide Adenine Dinucleotide).

  • When the amount of NADH increases, the body assumes that it has lots of energy.

Thus, leading to :

Inhibition of β-oxidation, a process where fats are broken down in the mitochondria to provide energy. Since, the body has enough energy in the form of NADH, it stops fat burning.

Increased Fat Synthesis (Lipogenesis): The same NADH excess stimulates triglyceride synthesis.

       Alcohol also activates SREBP-1c (Sterol Regulatory Element-Binding Protein), a transcription     factor that turns on genes involved in fat synthesis.

Therefore, the body is making more fat and burning less fat.

3. Alcohol Blocks Fat Export

  • Normally, the liver packages fat into particles (called VLDL) that carries it to the bloodstreams to send to other parts of the body.
  • Alcohol slows down or blocks this export system, so fat stays trapped in the liver cells.

Thus, fats are accumulated in the liver upon excess consumption of alcohol.

Non-Alcoholic Fatty Liver Disease (NAFLD):

Who usually gets NAFLD?

NAFLD is very common, especially in people who:

  1. Are overweight or obese
  2. Have type 2 diabetes or prediabetes
  3. Have high cholesterol or triglycerides
  4. Have insulin resistance
  5. Are over 40 (but even teens and kids can get it now)
  6. Have a family history of fatty liver, diabetes, or obesity
  7. Live a sedentary lifestyle (lack of exercise)

How does NAFLD happen?

  1. INSULIN RESISTANCE:

Insulin– Insulin is a hormone that helps sugar (glucose) go from your blood into your cells for energy.

Why does the body become insulin resistant?

When a person eats  too much sugar or carbs and don’t burn that energy with activity…

Glucose content in the blood increases and thus, your body makes a lot of insulin again and again. As a result, cells get tired of insulin knocking all the time.

So, they stop opening up and doesn’t respond to insulin.

This is called Insulin resistance.

  • LIVER GETS OVERLOADED WITH FAT:

Fat coming from the blood (outside)– When you eat too much junk food or are overweight, extra fat floats around in your blood. This fat is called free fatty acids. Your liver pulls this fat in.

So the liver is soaking in fat from the outside.

Fat being made inside the liver-  When you eat too much sugar or carbs (like sweets, bread, rice, soft drinks), it turns into glucose (sugar in blood). your body makes extra insulin, which tells your liver to turn that sugar into fat even if your body doesn’t need it.

So now the liver is making fat inside from all that sugar.

  • FAT GETS TRAPPED IN LIVER CELLS:

The liver usually sends fat out by packaging it into VLDL (Very Low-Density Lipoprotein) particles —  delivering fat to other parts of the body.

But in NAFLD:  This system gets slowed down or blocked.

 Nutrients like choline (needed to make VLDL) might be missing.

The liver is too overwhelmed to send the fat out efficiently.

Fat builds up inside liver cells, turning them into fat-stuffed cells.

TWO STAGES OF NAFLD

  1. Stage 1: Simple Fatty Liver (NAFL)-  In the initial stage, fat starts building up inside your liver cells. No severe damage is caused with no symtoms. It can be corrected with healthy eating, exercise and weight loss.
  2. Stage 2: NASH (Non-Alcoholic Steatohepatitis)- The fat will start causing inflammation and damaging the liver cells. It can cause pain and discomfort in the upper right belly.  Ignorance can lead to fibrosis and even liver failure.

Why is fatty liver so common nowadays?  

Fatty liver has become very common these days mainly because of modern lifestyle habits. People eat more junk food, sugary drinks, and processed carbs than ever before. At the same time, many don’t get enough physical activity — we sit a lot (at desks, on phones, watching TV) and burn very few calories. This creates a situation where the body has too much energy (glucose and fat), but nowhere to use it — so the liver stores it as fat. Also, stress, poor sleep, alcohol, and late-night eating make things worse. Even young people and those who aren’t obese can get it, especially if they have insulin resistance or genetic risk.

How to Prevent or Stop Fatty Liver:

  1. Eat healthier:
    • More fruits, vegetables, whole grains, and healthy fats (like nuts and olive oil)
    • Cut down on added sugar, white bread, soda, and fried food
  2. Move more:
    • Aim for at least 30 minutes of exercise (like walking, dancing, or cycling) daily
  3. Sleep well:
    • Poor sleep messes with insulin and increases fat storage
  4. Manage stress:
    • Stress hormones can worsen fat buildup in the liver
  5. Limit alcohol:
    • Even small amounts of alcohol can damage the liver
  6. Check-ups:
    • Get your liver enzymes, sugar levels, and cholesterol checked regularly

“Feed your liver with real food, not fake fuel. Move daily, rest deeply, and drink wisely — your liver works silently, but speaks loudly when ignored.”

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