Understanding the Silent Progression of Liver Disease
Fatty liver disease is currently one of the most common liver ailments treated in clinical practice. It is driven primarily by rising rates of obesity and type 2 diabetes. The condition typically develops silently; as endocrinologist Dr. Ayushi Dixit tells GB News, it “usually starts out as symptoms and may not even show up on labs until it has progressed.”
The condition is caused by a build-up of fat in the liver cells. While often linked to excess alcohol intake, it can also occur alongside metabolic syndrome, obesity, and insulin resistance, as seen in type 2 diabetes. Crucially, the liver continues functioning normally even as damage builds, which is why Dr. Dixit notes it is so often overlooked or underdiagnosed. Over time, excess fat deposition slowly causes healthy tissue to scar, in a process clinically known as fibrosis, making it progressively harder for the liver to perform its vital functions.
The liver is an organ about the size of a football that filters toxins from the blood, makes enzymes that help digest food, stores sugar and nutrients, and helps fight infections. Grace L. Su, MD, professor of internal medicine and surgery at the University of Michigan Medical School and chief of the Gastroenterology and Hepatology Section at the VA Ann Arbor Healthcare System, describes the organ as essentially the factory of the body.
According to Dr. Suresh Raghavaiah, Senior Consultant, HPB and Multi-Organ Transplant at Apollo Hospitals, Bangalore, many people wrongly believe liver disease only affects those who drink alcohol. In reality, metabolic dysfunction-associated steatotic liver disease (MASLD)—previously known as non-alcoholic fatty liver disease—is now one of the leading causes of liver damage. It is closely linked to obesity, diabetes, unhealthy eating habits and physical inactivity.
Risk Factors and the Role of Visceral Fat
The greatest risk factors for fatty liver disease include type 2 diabetes, pre-diabetes, insulin resistance, and high cholesterol or triglycerides. Dr. Dixit notes that the disease can also affect individuals with a normal body weight who have a genetic predisposition, as well as those with hepatitis or HIV. Imaging scans often detect the condition before blood tests or symptoms do.
For more on this story, see Experimental drug reverses severe fatty liver disease by repairing the gut.
A significant health concern is abdominal fat, which causes the waistline to expand. A waist circumference greater than 34.6 inches for women and 40 inches for men is associated with an increased risk for cardiometabolic disease. This fat, called visceral adipose tissue, accumulates deep in the abdomen and surrounds organs such as the liver, pancreas, and kidneys. Unlike fat stored just under the skin, visceral fat is metabolically active and inflammatory. Dr. Faridi notes that “BMI doesn’t address any of that—it doesn’t address how much adipose tissue a person has, or importantly, where that fat is located.” He adds, “We know this extra fat tissue in the belly is not benign—it can contribute directly to disease.”
Obesity is linked to more than 200 conditions, including heart disease, diabetes, high blood pressure, fatty liver disease, sleep apnea, osteoarthritis, and certain cancers. Waist circumference thresholds vary by population; for instance, recommended cutoffs are lower for Asian adults—31.5 inches for women and 35.4 inches for men—because diabetes and related conditions tend to develop at lower body weights.
This follows our earlier report, How to Tell if Your Liver Is Healthy: Belgian Study Reveals Why Liver Cancer Grows Aggressively.
Progression to Cirrhosis
Cirrhosis is a condition in which scar tissue gradually replaces healthy liver cells. Each time the liver is hurt, it repairs itself and forms tough scar tissue. When too much scar tissue builds up, the organ cannot work as it should. While most damage to the liver cannot be fixed, catching it early may allow for treatments that keep problems in check.
According to the British Liver Trust, cirrhosis can lead to a loss of appetite and weight loss because it becomes more difficult for the body to process food. The organization explains that “your liver is no longer able to store glycogen, a form of carbohydrate which it needs to meet your body’s energy demands.” Additionally, the British Liver Trust notes that bowel movements help rid the body of toxins, and having fewer bowel movements can cause toxins to build up in the body.
Broader Digestive Health Considerations
Other digestive conditions, such as diverticulitis, are also influenced by lifestyle and diet. The Mayo Clinic states that a diet low in fiber and high in animal fat can increase the risk of developing diverticulitis, an inflammatory disease of the colon. A sedentary lifestyle, smoking, alcohol, and excessive caffeine consumption can also contribute to the condition, which has been linked with obesity.
Read also: 9 Daily Habits That Can Damage Your Liver (Beyond Alcohol).
Regarding medication, nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with an increased risk of diverticulitis. However, this observation is not definitive. One study found that NSAIDs as a class of drugs more than tripled the risk of diverticulitis, but that aspirin, also an NSAID, did not increase the risk.
Diverticulitis develops from diverticulosis, where small, saclike pouches called diverticula form on the wall of the digestive tract, per the Cleveland Clinic. These are not dangerous by themselves, but they can rupture, leading to diverticulitis. If you experience symptoms related to these conditions, it is important to consult a qualified medical professional for diagnosis and treatment, as individual health circumstances vary.
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