Understanding Steatotic Liver Disease (SLD)

The Role of the Liver

The liver is the largest internal organ in your body. It weighs about 1.5kg and is the size of a football. Your liver performs lots of important functions including cleaning your blood, helping with digestion and regulating energy levels by storing and releasing sugar (glucose) when needed.

A normal healthy liver contains little to no fat. However, with a metabolic condition such as diabetes, fat can build up in the liver and the liver cannot work as it should. This process also increases the risk of other health conditions such as heart disease, kidney disease and liver failure.

Causes of Steatotic Liver Disease

Eating more than your body’s energy needs can lead to extra fat storage in your liver which increases your risk of developing metabolic problems and steatotic liver disease.

However, SLD is not just caused by carrying extra weight. It usually occurs from a combination of factors that are present over a long period of time. These include:

• Waist circumference over 94cm for men and over 80cm for women
• An unhealthy diet (high in fat, salt, and sugar)
• Low physical activity levels
• Prolonged sitting
• Smoking
• High blood pressure (hypertension)
• High blood sugar levels
• High triglycerides (a type of fat in your blood)
• High LDL ("bad") cholesterol
• Low HDL ("good") cholesterol
• Excessive alcohol consumption (more than 10 standard drinks per week or more than 4 in a single day)

Additional Risk Factors

Although excess weight is considered a large risk factor - approximately 40% of individuals with SLD are not overweight. There are some additional risk factors which may increase your risk, these include:

• A family history of fatty liver disease or obesity
• Polycystic ovary syndrome (PCOS)
• Obstructive sleep apnoea
• Underactive thyroid (hypothyroidism)
• Overactive thyroid (hyperthyroidism)

Symptoms of Steatotic Liver Disease

Early symptoms of SLD are not always clear. A person may experience fatigue, low energy, a general feeling of being unwell, fullness, and discomfort in the upper right side of the abdomen. However, as the condition progresses, more severe symptoms may appear:

• Nausea
• Vomiting
• Loss of appetite
• Unexplained weight loss
• Yellowing of the skin and eyes (jaundice)
• Swelling in the abdomen (ascites)
• Swelling in the legs, feet, or hands (oedema)
• Spider-like blood vessels just beneath the skin
• Shortness of breath
• Itchy skin
• Black faeces

If you notice any of these symptoms, seek medical attention promptly.

Diagnosing Steatotic Liver Disease

To check for steatotic liver disease (SLD) your doctor may order liver function tests as part of routine blood tests. These results will give an initial indicator of your liver’s health.

If blood results indicate SLD, your doctor will likely order an abdominal ultrasound. This is a quick and painless procedure and is usually enough to diagnose the presence of fat on your liver. A fibroscan may also be ordered if liver scarring and damage is suspected.

Managing and Treating Steatotic Liver Disease

The good news is that the liver is an amazing organ that can repair itself and re-grow healthy tissue. Depending on the stage of SLD, it may be possible to reverse liver damage through lifestyle changes such as:

• Maintaining a healthy weight
• Engaging in regular exercise (at least 30 minutes of moderate exercise, 5 days a week)
• Eating a balanced and nutritious diet
• Keep blood glucose levels in target as much as possible
• Limiting or avoiding alcohol
• Managing other risk factors, such as blood pressure, cholesterol, and blood sugar levels
• Avoiding medications that can impact liver health (e.g. some herbal remedies (check with your doctor or pharmacist) and
• Quitting smoking

Not all cases of SLD can be prevented, and some liver damage may not be able to be reversed. Early detection and identifying your risk factors are key. Talk to your doctor about your current risk and how you and your health care team can help to manage key risk factors.
For more information on liver health or steatotic liver disease, you can:

• Call LiverLine on 1800 703 003 or
• Visit LiverWell.org.au

Additional Information for improving your health

Blood Glucose Monitoring Fact Sheet
Diabetes Annual Cycle of Care Fact Sheet
Physical Activity Fact Sheet
Healthy Eating