The result I focus on is scarring, not just fat
If a scan report says fatty liver, I do not use the amount of brightness on the scan as a measure of permanent damage. I check metabolic health, alcohol and other possible causes, then assess the likelihood of significant scarring. Normal liver enzymes are reassuring in some respects but cannot settle that question on their own.
In New Zealand, further testing and referral depend on the clinical findings and the local pathway. FIB-4 is a blood-test-based score, and FibroScan is a non-invasive liver stiffness measurement; both can be used to assess for fibrosis. People with low fibrosis risk can often continue planned monitoring with their GP rather than having repeated ultrasound scans simply to recheck fat.
Guidance behind this advice
Fat, inflammation and scarring are different
Fat
Steatosis means fat droplets have accumulated within liver cells. A scan showing fat does not by itself establish inflammation or cirrhosis.
Fat
Steatosis means fat droplets have accumulated within liver cells. A scan showing fat does not by itself establish inflammation or cirrhosis.
Inflammation
Steatohepatitis includes inflammation and liver cell injury as well as fat.
Scarring
Fibrosis means scar tissue. Not everyone with liver fat develops advanced fibrosis. The amount and distribution need clinical assessment.
How scarring can progress
Repeated or persistent inflammation can gradually increase fibrosis. Symptoms may appear late, so treatment and risk reduction are important before advanced scarring develops.
Checking fibrosis
Your history and blood results guide whether a liver stiffness test or further assessment is appropriate. These tests are interpreted together.
Simplified illustrations, not to scale. These show an example, not your own anatomy or test result.
Read every diagram explanation
Fat
Steatosis means fat droplets have accumulated within liver cells. A scan showing fat does not by itself establish inflammation or cirrhosis.
Inflammation
Steatohepatitis includes inflammation and liver cell injury as well as fat.
Scarring
Fibrosis means scar tissue. Not everyone with liver fat develops advanced fibrosis. The amount and distribution need clinical assessment.
How scarring can progress
Repeated or persistent inflammation can gradually increase fibrosis. Symptoms may appear late, so treatment and risk reduction are important before advanced scarring develops.
Checking fibrosis
Your history and blood results guide whether a liver stiffness test or further assessment is appropriate. These tests are interpreted together.
Fat, inflammation and scarring are different
Steatosis means fat has built up inside liver cells. Steatohepatitis means there is inflammation and liver cell injury as well. Fibrosis means scar tissue. Cirrhosis is advanced scarring that changes the structure of the liver.
These are different findings, rather than an inevitable sequence. Many people with liver fat do not develop advanced scarring. In others, inflammation and fibrosis can develop over time. Treatment can reduce liver fat and inflammation, and some scarring can improve.
Why might fat build up in the liver?
Liver fat often occurs alongside type 2 diabetes, raised blood fats, high blood pressure or excess weight around the waist. When fat is associated with these metabolic factors, the current name is metabolic dysfunction-associated steatotic liver disease (MASLD).
Older reports may call it non-alcoholic fatty liver disease (NAFLD). MASH describes the associated inflammation and liver cell injury.
Alcohol and metabolic health can both contribute to liver fat. Some medicines and other health conditions can contribute too. Liver fat can also occur in people who are not overweight. I ask about your health, alcohol intake and medicines because a scan cannot show the cause by itself.
How do I check for scarring?
Most people have no symptoms. An ultrasound can suggest fat but does not reliably tell us whether there is inflammation or how much scarring is present. Normal liver blood tests do not completely exclude significant fibrosis either.
I use your history and blood results to decide whether further assessment is needed. FIB-4 is a calculation using age, liver enzymes and the platelet count to estimate the likelihood of advanced fibrosis. It is a guide, not a diagnosis, and its interpretation depends on age and clinical circumstances.
A FibroScan or another liver stiffness test can provide more information. A high stiffness result needs interpretation because factors other than scarring can affect it. Some people need additional blood tests, specialist review or, less often, a liver biopsy.
What can I do to improve liver health?
I recommend sustainable changes to food and activity, with support that suits your health and daily life. A Mediterranean style of eating, fewer sugary drinks and regular activity can help. If weight reduction is appropriate, gradual weight loss can reduce liver fat and inflammation. Exercise can help even without a large change on the scales.
Managing diabetes, blood pressure and cholesterol is also part of treatment. Heart and blood vessel health deserve attention alongside the liver. Some people benefit from medicines for diabetes or weight management; selected liver disease may need specialist treatment.
Emerging evidence for GLP-1 medicines such as semaglutide (Wegovy) in selected people with MASH and significant fibrosis is promising, and more data are expected. Whether it is appropriate depends on your diagnosis, other health conditions and local access. Options depend on your assessment and local availability.
Alcohol can add to liver injury. I will discuss reducing or avoiding it; with advanced fibrosis or cirrhosis, I recommend avoiding alcohol. If you drink heavily or may be dependent, ask for help to reduce safely. Avoid liver detox products and check supplements with your clinician or pharmacist.
Will I need ongoing checks?
Follow-up depends on the fibrosis assessment, your metabolic health and other causes of liver disease. Some people can be monitored by their GP, while others need specialist care. I will explain which tests are needed and when. A finding of liver fat alone does not mean everyone needs repeated scans or liver cancer surveillance.
When to seek medical advice
Contact me or your GP promptly for yellow eyes or skin, new abdominal swelling, leg swelling or unexplained weight loss. These symptoms need assessment and should not be assumed to be ordinary fatty liver.
Seek urgent help for vomiting blood, black tarry stools, new confusion or severe illness.
Call 111 if you collapse, have bleeding with faintness or are too unwell to travel safely.
Three things to remember
- Liver fat, inflammation and scarring are different findings. Progression to cirrhosis is not inevitable.
- I check for liver scarring and its causes, as well as diabetes and risks to your heart health.
- Food, activity, individual weight goals and alcohol advice can help. Follow-up depends on your results.
Related information
Sources and further reading
English clinical master checked 15 October 2026.