A Cleveland Clinic liver specialist discusses the life expectancy with fatty liver disease and provides tips to take charge of your health.
Life Expectancy with Fatty Liver Disease: An Expert Doctor Explains
Published on Dec. 24, 2024
According to the American Liver Foundation, a nonprofit organization dedicated to raising awareness and advocating for liver health, approximately 25% of people in the United States are affected by nonalcoholic fatty liver disease. This condition occurs when excess fat accumulates in the liver without alcohol being a contributing factor. Given the prevalence of this condition, it’s natural to question its potential impact—and to feel inclined to search for answers on life expectancy with fatty liver disease.
As the body’s largest internal organ, the liver is responsible for detoxifying harmful substances, producing bile to aid digestion, storing essential nutrients, and regulating blood sugar and cholesterol levels. When the liver is compromised by fatty liver disease, its ability to perform these critical functions may decline, leading to serious health complications.
Ahead, Jamile Wakim-Fleming, MD, a board-certified gastroenterologist and director of the Center for Metabolic Steatosis of the Liver at Cleveland Clinic, explains what you need to know about fatty liver disease, including insights into life expectancy with fatty liver disease and how proactive management can make a difference.
What is fatty liver disease?
“Fatty liver disease is a term that describes the presence of fat in the liver cells,” Dr. Wakim-Fleming explains. However, as of 2023, this condition is now referred to as “steatosis of the liver.” It was renamed to better represent its underlying causes. While factors such as obesity can raise the risk of developing steatosis, many other risk factors are unrelated to weight.
“Steatosis of the liver is a progressive disease that can cause inflammation of the liver and subsequently scarring, or fibrosis, and that ultimately may lead to cirrhosis if no intervention is applied,” she adds.
Types of fatty liver disease
Steatotic liver disease is an umbrella term for conditions involving fat buildup in the liver. It encompasses the following types:
- Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Formerly known as non-alcoholic fatty liver disease (NAFLD), MASLD is associated with conditions such as obesity, diabetes, and high cholesterol. A more severe form, called metabolic-associated steatohepatitis (MASH), occurs when fat accumulation in the liver triggers inflammation, leading to tissue damage and scarring (fibrosis).
- Alcohol-Related Liver Disease (ALD): ALD is caused by excessive alcohol intake, which can severely damage the liver over time. When the liver processes alcohol, some liver cells die, and while the organ typically regenerates new cells, excessive drinking can overwhelm its ability to repair itself.
- MetALD: A newly classified overlap between MASLD and ALD, highlighting cases where both metabolic dysfunction and alcohol use contribute to liver damage.
- Rare causes of liver steatosis: These include certain genetic disorders, medications, or infections that lead to fat accumulation in the liver.
Stages of fatty liver disease
Steatosis of the liver progresses through several stages, each with increasing levels of liver damage, says Dr. Wakim-Fleming. They include:
- Simple steatosis: This is the initial stage, where fat accumulation in the liver occurs but has not yet caused harm.
- Steatohepatitis: The second phase involves inflammation of the liver, known as steatohepatitis. This inflammation indicates that the liver is beginning to sustain damage.
- Fibrosis: In the third phase, the combination of ongoing inflammation and scarring (fibrosis) occurs. Fibrosis reflects the liver’s attempt to repair itself, but excessive scarring can impede its function over time.
- Cirrhosis: The final stage, cirrhosis, develops when fibrosis progresses further, leading to extensive scarring and severe liver damage. At this stage, the liver’s ability to function is significantly impaired, and complications, such as liver failure or liver cancer, can arise.
Symptoms of fatty liver disease
“In general, there are no symptoms for steatosis of the liver,” cautions Dr. Wakim-Fleming. “Individuals are discovered to have steatosis of the liver incidentally.” In other words, it is often detected during evaluations for unrelated issues, such as through imaging tests that reveal fatty deposits in the liver or abnormal results in liver function tests.
Life expectancy with fatty liver disease
Life expectancy with fatty liver disease depends on its type and stage. “But usually progress slowly over 10 to 15 years before cirrhosis develops,” says Dr. Wakim-Fleming.
According to the Cleveland Clinic, for most people, steatosis of the liver doesn’t cause significant problems unless it advances to cirrhosis. Many individuals with this condition can maintain a normal life expectancy with proper management. However, untreated cirrhosis can eventually lead to liver failure or liver cancer, both of which are life-threatening.
Fatty liver disease complications
- Liver damage: Fibrosis, cirrhosis, or liver failure.
- Liver cancer: Increased risk with advanced disease.
- Cardiovascular issues: Higher risk of heart disease and stroke.
- Metabolic disorders: Worsened diabetes, obesity, and high cholesterol.
- Portal hypertension: Elevated pressure in the portal vein, leading to complications like varices.
- Infections and malnutrition: Weakened immune system and nutrient deficiencies.
- Cognitive impairments: Confusion or memory problems due to toxin buildup (hepatic encephalopathy).
How fatty liver disease is diagnosed
“Most of the time [steatosis of the liver] is seen on imaging of the liver such as ultrasound, MRI or CT,” explains Dr. Wakim-Fleming.
In addition, blood tests can assess liver health by calculating scores such as the FIB-4 index, which evaluates fibrosis risk based on factors like age, liver enzyme levels, and platelet count, and the ELF (Enhanced Liver Fibrosis) score, which measures specific biomarkers of liver scarring.
For cases where there is uncertainty or more detailed information is needed, a liver biopsy may be performed.
Fatty liver disease causes and risk factors
According to Dr. Wakim-Fleming, fatty liver disease often develops when individuals have at least two of the following risk factors:
- High blood Pressure
- Abnormal lipid levels (elevated cholesterol or triglycerides)
- Diabetes
- Obesity
- Excess abdominal fat
However, it’s important to note that steatosis can also affect those with a normal weight. Even lean individuals may develop this condition.
For individuals who consume alcohol, the risk of fatty liver disease increases significantly. ALD can result from excessive or prolonged alcohol consumption, genetic predispositions that affect how the body processes alcohol, and poor diet or malnutrition, which often accompanies heavy drinking.
Children may develop fatty liver disease due to obesity, unhealthy diets, and a sedentary lifestyle. Genetic predispositions and conditions like insulin resistance also play a significant role in increasing their risk.
How fatty liver disease is treated
“It is only in 2024 that a medication was approved for managing patients with steatosis and fibrosis,” explains Dr. Wakim-Fleming. The U.S. Food and Drug Administration (FDA) approved resmetirom, sold under the brand name Rezdiffra. This daily pill works by activating a thyroid hormone receptor to reduce liver fat accumulation.
For individuals with obesity, weight loss surgery may be an option. This approach has been shown to reduce risk factors and improve liver health.
Ways to prevent fatty liver disease
Preventing or managing fatty liver disease starts with addressing key lifestyle factors. According to Dr. Wakim-Fleming, a proactive approach is essential for liver health. Here are the steps you can take:
- Maintain a healthy weight: Achieve and sustain a weight that supports overall health.
- Control blood pressure: Monitor and manage blood pressure to avoid additional strain on the liver.
- Manage diabetes and cholesterol: Keep blood sugar and cholesterol levels within healthy ranges.
- Stay active: Aim for at least 150 minutes of physical activity per week. Choose activities you enjoy to make exercise sustainable.
- Eat balanced meals: Incorporate nutrient-rich foods like vegetables, fruits, whole grains, and lean proteins into your diet.
- Limit alcohol: Reduce or abstain from alcohol consumption to minimize liver damage.
- Avoid harmful medications: Steer clear of unnecessary medications that could harm the liver.
- Regular check-ups: Routine health screenings can catch abnormalities early, allowing for timely intervention.
- Seek professional help: If needed, work with specialists for weight management, structured exercise plans, or advanced liver care.
- Consider medical options: In some cases, medical or surgical interventions may be necessary.
About the expert:
Jamile Wakim-Fleming, MD, is a board-certified gastroenterologist and director of the Center for Metabolic Steatosis of the Liver at Cleveland Clinic. Appointed in 2002, her expertise encompasses all liver and hepatobiliary disorders, including metabolic, autoimmune, and viral conditions, as well as end-stage liver disease and its complications. She also specializes in pre- and post-liver transplantation care, along with liver disorders specific to women and pregnancy.
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