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30th January, 20205 min read

What are the early signs of fatty liver disease?

Medical reviewer: Healthily's medical team
Author: Alex Bussey
Last reviewed: 30/01/2020
Medically reviewed

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The early signs of fatty liver disease tend to be subtle and hard to spot. Both types of fatty liver disease - alcohol-related (ARLD) and non-alcoholic fatty liver disease (NAFLD) - are usually ‘silent’ conditions with few or no symptoms.

But as the disease progresses, the symptoms can become more obvious.

Knowing the signs to look out for is important as it’s possible to stop further liver damage and even reverse the effects of fatty liver disease if you take action early enough.

The stages and early signs of fatty liver disease

The first stages of NAFLD are generally harmless, but the condition can lead to permanent liver damage if it’s not managed properly.

If it does progress, it normally develops in 4 stages:

  1. Simple fatty liver (steatosis), where a small amount of fat builds up in the liver cells.
  2. Non-alcoholic steatohepatitis (NASH), when the liver cells become inflamed.
  3. Fibrosis, where fibrous scar tissue replaces damaged liver cells.
  4. Cirrhosis, where scar tissue prevents the liver from functioning properly.

Simple fatty liver (steatosis)

If you have simple fatty liver, a small amount of fat will have built up in your liver cells but there won’t be any scarring or inflammation. This stage of fatty liver disease can be treated - and even reversed - by making changes to your diet and lifestyle. Find out more about the best diet for fatty liver disease.

Because the early signs of fatty liver disease are difficult to spot, NAFLD is normally diagnosed while testing for another (unrelated) medical condition, so you’re not likely to notice any symptoms.

However, some people may feel generally unwell or experience a little discomfort in the right side of the tummy if the disease has reached a stage where there is damage to the liver.

If you have these symptoms and are worried, see a doctor.

Non-alcoholic steatohepatitis (NASH)

If the build-up of fat in your liver causes inflammation, you may develop NASH. NASH is a more serious medical condition that can lead to permanent scar tissue in your liver.

Most cases of NASH don’t cause any symptoms, but some people with NASH do notice pain or discomfort in the upper right side of their tummy. You may also feel unwell, tired or weak.


The liver is good at healing itself. However, inflammation and liver damage can lead to the development of fibrous scar tissue. Over time, this tissue can stop the liver from working properly and lead to cirrhosis, but your liver should still function fairly well during the early stages of fibrosis.

If you have fibrosis, you may experience symptoms of appetite loss, nausea, weakness or unexplained weight loss. You may also notice a yellowing of the skin and whites of the eyes (jaundice).

You can have liver fibrosis without any symptoms. In fact, studies show that around 6 to 7% of the world’s population is unaware they have liver fibrosis because they don’t have symptoms.


Cirrhosis is a serious condition that develops when scar tissue replaces healthy tissue in the liver and stops the organ from working properly. It’s unusual for NAFLD to lead to cirrhosis, but when it happens, cirrhosis can’t be reversed and can lead to liver failure.

If you develop cirrhosis, you may notice symptoms such as:

  • itchy skin
  • hair loss
  • weight loss
  • swelling of the lower tummy area
  • yellowing of the skin or eyes (jaundice)
  • pain around the liver area
  • a fever
  • swelling in the legs, feet or ankles

If you spot any of these symptoms, you should seek immediate medical attention.


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Dyson J, Anstee Q, McPherson S. Non-alcoholic fatty liver disease: a practical approach to treatment. 2020. Available here.

Information H, Disease L, NASH N, Facts D, NASH D, Center T et al. Definition & Facts of NAFLD & NASH | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. 2020 [cited 22 January 2020]. Available here.

Non-alcoholic fatty liver disease (NAFLD) - NICE CKS [Internet]. 2020 [cited 22 January 2020]. Available here.

Cirrhosis of the Liver - Symptoms, Diagnosis & Treatment from Your.MD [Internet]. Your.MD. 2020 [cited 22 January 2020]. Available here.

Non-alcoholic fatty liver disease (NAFLD) - NICE CKS [Internet]. 2020 [cited 22 January 2020]. Available here.

Liver Fibrosis: Stages, Treatment, and Symptoms [Internet]. Healthline. 2020 [cited 22 January 2020]. Available here.

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