Liver health in focus – Why fatty liver has become a widespread disease and what we can do

A silent giant in the body

Our liver is a true multitalent: Weighing up to two kilograms, it is the largest metabolic organ and performs over 500 different functions. It filters toxins from the blood, stores energy in the form of glycogen, produces bile for fat digestion, and plays a central role in the hormonal and immune systems. Around 1.5 liters of blood flow through it every minute—tirelessly, day and night. But this very powerful organ is increasingly under threat worldwide—from a disease that often goes undetected for years: fatty liver.

The liver in numbers

  • Weight: approx. 1.4–2.0 kg

  • Tasks: over 500 different metabolic functions

  • Blood flow: approx. 1.5 liters per minute

  • Regeneration capacity: can fully recover if the cause is eliminated in time

Fatty liver – an underestimated danger

In Germany, it is the most common liver disorder: approximately 23% of the population is affected, and worldwide, it is estimated that over a billion people are affected. In fatty liver disease, fat accumulates in the liver cells. This alone is not necessarily dangerous, but under unfavorable conditions, it can lead to inflammation and permanent damage. The main causes are diverse. Obesity, elevated blood lipid levels, insulin resistance, or type 2 diabetes are particularly common. Excessive alcohol consumption also plays a major role. In addition, certain medications, other liver or metabolic diseases such as celiac disease or Wilson's disease, and a combination of several risk factors can contribute to fatty liver disease. Since 2023, new medical terms have also been in effect: MASLD refers to metabolic dysfunction-associated fatty liver disease, MASH the inflammatory form, MetALD a combination of metabolic factors and alcohol consumption, and cryptogenic SLD a fatty liver of unknown cause.

Fatty liver worldwide

  • Germany: approx. 23% of the population

  • Europe: around 80 million affected

  • Worldwide: over 1 billion affected

  • Increasing numbers also among children and adolescents, especially overweight

Why fatty liver disease is often not noticed

One of the biggest challenges with fatty liver disease is that in many cases it doesn't cause any symptoms. This is because the liver tissue itself has no pain receptors – so it can't directly "report" when it's damaged. Only when the liver is severely enlarged or inflamed can a feeling of pressure or fullness in the right upper abdomen occur. These sensations are not caused by the liver cells themselves, but by the surrounding tissue, which is stretched when they enlarge. In addition, the few possible symptoms, such as fatigue, poor concentration, or general exhaustion, are very non-specific and are often attributed to other causes. Even changes in urine or stool usually only occur in more advanced stages. All of this means that fatty liver disease is often only discovered by chance during an ultrasound scan, perhaps as part of a routine check-up.

Possible warning signs

  • Long-lasting fatigue

  • Feeling of pressure in the right upper abdomen

  • Concentration problems

  • Rare: itching, change in urine or stool color

When it becomes dangerous

As long as it's purely a matter of fat deposits, the liver can often fully recover if the triggers are consistently addressed. It becomes problematic when inflammation occurs – known in medical terms as MASH . This significantly increases the risk of tissue scarring (fibrosis) or liver cirrhosis. This advanced damage is often irreversible. Furthermore, an inflamed fatty liver also increases the risk of cardiovascular disease and diabetes – to an extent that many underestimate. Studies show that heart failure is a more common cause of death in fatty liver patients than liver failure itself.

New technical terms since 2023

  • MASLD – metabolic dysfunction-associated fatty liver disease

  • MASH – inflammatory form of MASLD

  • MetALD – combination of metabolic factors and alcohol consumption

  • Cryptogenic SLD – fatty liver of unknown cause

The liver can recover – if we act

The good news is that the liver is an organ with exceptionally high regenerative capacity. If the cause of fat deposits is eliminated in time, the tissue can often completely regress. The key to this lies in consistent lifestyle adjustments. The first priority is a healthy, balanced diet, preferably Mediterranean, with plenty of vegetables, moderate amounts of fruit, high-quality vegetable oils, and fiber-rich foods. Sugary drinks, highly processed snacks, and high-fat convenience foods should be avoided as much as possible. Regular exercise improves metabolism and can reduce fat content in the liver—even if body weight loss is slow. Just 150 minutes of moderate activity per week can produce noticeable effects. Avoiding alcohol is also crucial, even if it wasn't the primary cause. Slow, controlled weight loss helps relieve strain on the liver. Crash diets or extreme fasting, on the other hand, are counterproductive, as they strain the metabolism and, in the worst case, can worsen fatty liver disease.

Prevention tips

  • Mediterranean, plant-based diet

  • Low-sugar and low-alcohol drinks

  • 150 minutes of exercise per week

  • Reduce weight gradually

  • Avoid highly processed foods

  • Fasting days

Conclusion

Fatty liver disease is one of the most common liver diseases today—often undetected for a long time, but by no means harmless. Those who know risk factors and act early can do much to improve their own liver health. With education, a healthy lifestyle, and targeted fasting, the path to a relieved, efficient liver can be actively supported.

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