Fatty liver disease sounds like something that happens to somebody else. Someone older, someone unwell, or someone who drinks too much. But in Australia, about one in three adults is estimated to have fatty liver disease, and many people have no idea it is there.
That is what makes it so important to talk about. It is often silent, often missed, and often brushed off as “just a bit of weight gain” or “slightly off blood tests” when in reality it can be an early warning sign that your metabolism is under strain.
This article is about the type of fatty liver disease that is not related to alcohol intake. It is the lifestyle- and nutrition-related form, often called non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD). It is strongly linked to excess body fat, insulin resistance, inactivity, poor diet quality, and over time, too much total energy coming in for the body to handle well.
What is fatty liver disease?
Fatty liver disease means excess fat has built up inside the liver. Some fat in the liver is normal, but when fat makes up more than about 5 to 10% of the liver’s weight, it is considered fatty liver disease.
In the non-alcoholic form, this happens because the liver is being overloaded metabolically rather than damaged primarily by alcohol. The liver becomes a storage and processing site for surplus energy, especially when there is a long-term pattern of excess calories, weight gain around the middle, poor insulin sensitivity, and diets high in refined carbohydrates, sugars, saturated fats, and ultra-processed foods.
The most common type in Australia is the metabolic form. People with obesity, prediabetes, type 2 diabetes, high blood pressure, and high cholesterol are at particular risk, even if they do not realise it yet.
How common is fatty liver disease in Australia?
The numbers are not small. Australian modelling estimated about 5.56 million people were living with non-alcoholic fatty liver disease in 2019, with projections rising to just over 7 million by 2030 if current trends continue.
The same modelling estimated an all-age prevalence of about 22.0% in 2019, while the Liver Foundation states that around one in every three Australian adults has fatty liver disease. Those figures are not contradictory. One looks at all ages in a model, while the other refers specifically to adults, where fatty liver is more common.
So yes, a very fair question for Australians is this: could you be one of the one in three?
What causes fatty liver disease?
For many people, fatty liver is the result of a lifestyle pattern rather than one single food or one single bad habit. The biggest contributors are usually excess total calorie intake, weight gain, too little physical activity, and diets high in sugary drinks, refined carbohydrates, saturated fats, and processed foods.
That does not mean carbohydrate is bad in a simplistic sense. It means the type, amount, and context of carbohydrate matter. A dietary pattern built around soft drinks, fruit juice, sweets, large serves of refined cereals, take-away foods, and ultra-processed snacks places a very different load on the liver than one built around vegetables, legumes, high-fibre whole grains, fruit, and minimally processed meals.
Key risk factors include sugary drinks, fatty foods, highly processed food, being sedentary, high waist measurement, insulin resistance, type 2 diabetes, high cholesterol, and high blood pressure.
Fatty liver disease symptoms
One of the trickiest things about fatty liver disease is that it usually causes no symptoms at all in the early stages. Most people are diagnosed only because a blood test or scan was done for another reason.
If symptoms do happen, they are often vague, such as fatigue or discomfort on the upper right side of the abdomen. That is why so many cases remain undiagnosed. A person can feel basically fine while their liver and wider metabolism are already under pressure.
How to test for fatty liver disease
If somebody is wondering whether they could have fatty liver disease, the first step is to speak with their GP. This matters especially if they carry weight around the middle, have prediabetes or type 2 diabetes, high cholesterol, high blood pressure, or a history of consistently poor diet quality and low physical activity.
Testing usually starts with liver function blood tests. These may show raised liver enzymes such as ALT, AST, and GGT, although normal liver enzymes do not always rule fatty liver out.
If fatty liver is suspected, doctors then look for signs of scarring, also called fibrosis. This can be assessed using blood-based calculations, ultrasound, FibroScan, and sometimes a liver biopsy in selected cases.
A simple message for readers is this: you do not need to guess. You can ask your GP for a proper assessment if you have the risk factors.
What can fatty liver disease lead to?
Fatty liver disease is often described as the liver manifestation of broader metabolic dysfunction. In plain language, it is rarely just about the liver. It is usually a sign that the whole system is struggling to manage energy, blood sugar, blood fats, and inflammation well over time.
That is why fatty liver is so often seen alongside conditions such as insulin resistance, type 2 diabetes, dyslipidaemia, and high blood pressure. People with this condition are also at increased risk of heart disease, kidney disease, and liver complications, and the wider burden of illness extends beyond the liver itself.
Some of the major health conditions linked to fatty liver disease include:
- insulin resistance
- prediabetes and type 2 diabetes
- high triglycerides and abnormal cholesterol
- high blood pressure
- heart disease and stroke
- kidney disease
- liver inflammation and fibrosis
- cirrhosis, liver failure, and liver cancer
- a higher overall metabolic risk profile that may also overlap with cognitive decline pathways
For dementia and Alzheimer’s disease, the relationship is best described carefully. Fatty liver shares important upstream drivers with cognitive decline, including insulin resistance, vascular dysfunction, chronic inflammation, high blood pressure, and dyslipidaemia. That makes it a meaningful metabolic warning sign, but not a simple one-cause explanation.
Why does this happen biologically?
The liver is central to how the body handles incoming energy. When calorie intake repeatedly exceeds what the body can use, and especially when that intake includes a high load of refined carbohydrates and sugary foods, the liver converts excess energy into fat and stores it.
Over time, this excess liver fat contributes to worsening insulin resistance, abnormal blood lipids, inflammation, and eventually scarring in some people. That is why fatty liver is such an important lead indicator. It often shows up before people receive a formal diagnosis of type 2 diabetes, cardiovascular disease, or more advanced liver disease.
Can fatty liver disease be reversed?
In many cases, yes. The encouraging part is that early fatty liver disease is often reversible, especially when it is picked up before major scarring has developed.
Following a healthy lifestyle can reverse fatty liver for many people, and losing about 5 to 10% of body weight can control and sometimes reverse the condition. The NIDDK states that doctors recommend weight loss to treat NAFLD and that weight loss can reduce fat, inflammation, and fibrosis in the liver.
Fatty liver disease treatment
There is no single medication that reliably fixes fatty liver disease on its own. Treatment focuses mainly on addressing the lifestyle and metabolic factors that caused it in the first place.
That usually includes:
- eating a healthier overall diet with less ultra-processed food and fewer sugary drinks
- reducing total calorie intake when weight loss is needed
- improving carbohydrate quality by cutting back refined carbs and added sugars
- increasing physical activity and reducing long periods of sitting
- improving blood sugar control if diabetes is present
- managing cholesterol and blood pressure well
The point is not perfection. It is creating a pattern the liver can recover from.
The practical nutrition message
For readers, the most useful takeaway is usually not cut everything out. It is to build meals around real food more often and reduce the foods that drive the biggest metabolic load.
That often means:
- more vegetables, legumes, fruit, lean proteins, fish, and minimally processed meals
- fewer sugary drinks, juices, sweets, pastries, take-away meals, and heavily processed snack foods
- smaller portions where total intake has crept up over time
- regular movement and resistance training to improve insulin sensitivity
This is also why a whole-food, calorie-aware approach is so powerful. It addresses the core drivers rather than just chasing the blood test result.
How Be Fit Food may help
At Be Fit Food, knowing what to eat and actually doing it consistently are often two very different things. This is especially true when life is busy, energy is low, and it feels like your metabolism is working against you.
That is why the meals are scientifically formulated by dietitians to help support healthy weight loss, blood sugar balance, improved insulin sensitivity, and overall metabolic health — all key factors involved in the management of fatty liver disease.
The meals are:
- high in protein to support satiety and muscle mass
- lower in carbohydrates to help reduce excess glucose load
- portion controlled to support calorie awareness
- made from real, whole food ingredients
- free from added sugars and artificial sweeteners
Combined with regular movement, good sleep, stress management, and medical guidance where appropriate, a structured nutrition approach can help support the lifestyle changes shown to reduce liver fat and improve metabolic health.
Sometimes the liver warning light is not bad news. Sometimes it is the opportunity to reset your health before more serious disease develops.
A question worth asking
If fatty liver disease affects around one in three Australian adults, and usually causes no symptoms, then this is a very reasonable question to ask: could you be one of them?
If you have weight gain around the middle, elevated cholesterol, high blood pressure, prediabetes, type 2 diabetes, low physical activity, or a diet high in refined and processed foods, it is worth getting checked. A conversation with a GP, a few blood tests, and possibly an ultrasound or FibroScan can give you a much clearer picture.
The good news is that fatty liver disease is often not the end of the story. For many people, it is the warning light that arrives early enough to do something about it.
References
1. Liver Foundation. Fatty Liver Disease. Liver Foundation Australia. Available at: https://liver.org.au/your-liver/liver-diseases/fatty-liver-disease/
2. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Nonalcoholic fatty liver disease burden: Australia, 2019–2030. *J Gastroenterol Hepatol*. 2020;35(9):1628-1635. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7540570/
3. Chalasani N, Porter LE, Bhattacharya A, et al. AASLD 2023 Practice Guidelines on the Clinical Assessment and Management of NAFLD. Summary slide set. Available at: https://med.emory.edu/departments/medicine/_documents/khakoo-aasld-assessment-management-of-nafld.pdf
4. Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. *Gut*. 2018;67(1):6-19. Available at: https://gut.bmj.com/content/67/1/6
5. Patel PJ, Banh X, Horsfall LU, et al. Fatty liver disease: a practical guide for GPs. *Aust Fam Physician*. 2013;42(7):444-447. Available at: https://www.racgp.org.au/afp/2013/july/fatty-liver-disease
6. National Institute of Diabetes and Digestive and Kidney Diseases. Nonalcoholic Fatty Liver Disease (NAFLD) & NASH. NIDDK. Available at: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
7. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of NAFLD & NASH. NIDDK. Available at: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes
8. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts of NAFLD & NASH. NIDDK. Available at: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts
9. Shang Y, Nasr P, Ekstedt M, et al. Nonalcoholic Fatty Liver Disease and Risk of Dementia: A Population-Based Cohort Study. *Neurology*. 2022. Available at: https://pubmed.ncbi.nlm.nih.gov/35831178/
10. Dai W, Ye L, Liu A, et al. Risk of dementia or cognitive impairment in non-alcoholic fatty liver disease: A systematic review and meta-analysis. *Front Aging Neurosci*. 2022;14:985109. Available at: https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.985109/full
11. Mantovani A, Zaza G, Byrne CD, Lonardo A, Zoppini G, Bonora E, Targher G. Increased risk of cardiovascular disease and chronic kidney disease in NAFLD. *Nat Rev Gastroenterol Hepatol*. 2018;15(5):285-295. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/22565095/
12. Jang HR, Kim Y, Kang E, et al. Non-Alcoholic Fatty Liver Disease and Its Association with Cardiovascular and Kidney Outcomes in Chronic Kidney Disease. *Nutrients*. 2024;16(7):955. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/39369705/
