Fatty liver is linked to higher heart disease risk and is often thought to affect only the liver, but doctors warn the heart may be at greater risk.
The condition—now widely described as metabolic dysfunction associated steatotic liver disease (MASLD)—affects about 30.2% of people worldwide, with rates above 40% in the Americas and Southeast Asia.
Researchers report that even when obesity and diabetes are considered, people with fatty liver face a higher risk of heart failure, suggesting the liver condition may independently drive cardiovascular disease.
Often, there are no symptoms, so many cases go unnoticed—a wake-up call for heart health and overall health.
8 common signs of fatty liver disease
Fatty liver disease is often called a “silent” condition because early symptoms can be easy to miss. Still, the body usually sends gentle signals when the liver needs care.
Learning to recognize these signs early can help protect long-term health and prevent bigger problems later on.
1. Persistent Fatigue That Doesn’t Go Away
This is not the usual tired feeling after a busy day. Many people with fatty liver disease describe a deep exhaustion that lingers, even after a full night’s sleep. When the liver is burdened with excess fat, it cannot process energy efficiently. As a result, the body feels worn down and low on strength.
2. Discomfort Under the Right Ribs
Another early sign can be a dull ache or pressure on the upper right side of the abdomen. Some people describe it as a heavy or “full” feeling. This often occurs because the liver becomes slightly enlarged as it stores excess fat, which presses against nearby areas.
3. Changes in Digestion and Appetite
Because the liver plays a major role in digestion, problems often show up around mealtime. You may notice:
- Loss of appetite, even for foods you once enjoyed
- Nausea, or feeling full after only a few bites
- Bloating and gas, especially after eating
Together, these changes can make meals uncomfortable and leave you feeling unsettled throughout the day.
4. Unexpected Weight Changes
While fatty liver is often linked to weight gain, unexplained weight loss can also occur. This happens when the liver struggles to process nutrients properly. When the body is not getting what it needs, muscle strength and energy levels can slowly decline.
5. Visible Changes You Can See
As the liver becomes more stressed, signs may appear on the outside of the body:
- Skin and eyes may develop a yellow tint, known as jaundice, or feel itchy without a clear reason
- Urine may turn dark, similar to tea, while stools may look unusually pale
- Swelling can occur in the legs or abdomen due to fluid buildup
These changes often signal that the liver needs immediate attention.
6. Easy Bruising and Bleeding
The liver helps make proteins that stop bleeding. When it is not working well, bruises may appear more easily, and small cuts may take longer to heal. These changes can be easy to overlook but are often an early warning sign, according to GCSA.
7. Chills or Flu-Like Feelings
As toxins accumulate, the immune system may respond. This can cause chills, body aches, or a mild fever, even when there is no cold or flu present.
8. Confusion or “Brain Fog.”
In more advanced stages, toxins such as ammonia can reach the brain. This may lead to memory problems, trouble concentrating, or a feeling of mental confusion that feels unusual or concerning.
Do signs differ for men and women?
While the main signs are similar, the experience can vary slightly, says Paras Health.
- Women may notice stronger fatigue, along with hormonal changes or irregular menstrual cycles
- Men more often report metabolic issues, such as high cholesterol, or discomfort focused in the abdomen
It is important to know that early-stage fatty liver disease may cause no symptoms at all. Many people only discover it during routine blood tests or imaging scans. This is why regular checkups play such an important role in protecting liver health.
Fatty liver and heart failure: why the warning matters
The American Heart Association stresses that MASLD is often overlooked but carries serious heart risks.
People with fatty liver are more likely to die from heart problems than from liver complications. This shifts the focus beyond the liver and puts heart failure front and center.
What is non-alcoholic fatty liver disease (NAFLD)?
Non-alcoholic fatty liver disease (NAFLD) happens when extra fat builds up in the liver without heavy alcohol use.
It is tied to obesity, type 2 diabetes, and metabolic syndrome. NAFLD spans a spectrum—from simple fat buildup (NAFL) to inflammation and scarring (NASH), fibrosis, cirrhosis, and in some cases, liver cancer.
Today, many clinicians use metabolic dysfunction-associated steatotic liver disease (MASLD) to describe the same condition and underline its metabolic roots, including high blood sugar, high cholesterol, high blood pressure, and excess weight.
Fatty liver and heart failure: what a landmark study found
A long-term study from Duke University followed 570 adults with biopsy-confirmed MASLD over a median of 11 years.
The numbers were striking: 17.9% developed heart failure, and nearly 48% showed signs of possible heart problems that had not been diagnosed.
Risks were highest among older adults, women, and people with diabetes. This was the first study to use liver biopsy—the gold standard—to confirm the diagnosis before tracking heart outcomes.
It exposed a blind spot: many patients with fatty liver are not being monitored for heart health, leading to missed chances for early care.
How strong is the evidence linking NAFLD, MASLD, and heart failure?
Evidence keeps building. MASLD is recognized as an independent risk factor for atherosclerotic cardiovascular disease, which can lead to heart attacks and strokes.
A major meta-analysis of 11+ million people found NAFLD is tied to a 1.5-fold higher risk of heart failure, independent of age, obesity, or diabetes.
Studies also show shared drivers—insulin resistance, obesity, and chronic inflammation—and describe harmful heart changes, especially HFpEF, when the heart muscle does not relax well.
In the United States, heart-failure–related deaths among people with NAFLD have doubled over two decades, with sharper rises among women and in specific rural or Southern communities.
Large cohorts, including the UK Biobank, link MASLD to higher overall deaths, more cardiovascular deaths, and major cardiac events—even among non-drinkers.
Research in the Journal of the American College of Cardiology also reports higher risks of cardiomyopathy, arrhythmias, and atherosclerosis in these patients.
Why fatty liver can harm the heart
Scientists point to a chain of effects: fat-loaded liver cells drive inflammation and insulin resistance, which injure blood vessels and strain the heart.
Endothelial dysfunction, oxidative stress, and systemic inflammation add stiffness to arteries and reduce heart performance.
In simple terms, fatty liver signals a wider metabolic imbalance that overlaps with high lipids, hypertension, and diabetes—all of which raise the odds of heart failure.
Fatty liver and heart failure: what to do now
Early detection matters. Spotting non-alcoholic fatty liver disease and MASLD can flag hidden heart risk.
Experts advise that adults with MASLD, especially those with diabetes or high cholesterol, should also be screened for heart issues— including diastolic dysfunction and early heart failure.
Some treatments help both organs: ACE inhibitors, ARBs, and SGLT-2 inhibitors may benefit patients with MASLD and heart failure.
Just as necessary, lifestyle steps—balanced eating, regular activity, weight control, and better blood sugar and cholesterol—lower risk.
Because non-alcoholic fatty liver disease is not caused by alcohol, many people may not realize how daily lifestyle habits quietly push both liver and heart into danger.
A hopeful takeaway for people with fatty liver
Fatty liver—whether labeled NAFLD or MASLD—is more than a liver issue.
With nearly one in five developing heart failure over time and an apparent rise in risk seen across extensive studies, attention and action are vital.
The good news: with better screening, the right medicines, and steady lifestyle changes, people can protect the liver, shield the heart, and change the story.
Watch this video from Doctor Khalid as he explains the early warning signs of fatty liver disease and why spotting them early can save lives:
Disclaimer: This article is for informational purposes only and is not intended to serve as a substitute for professional advice, diagnosis, or treatment. Always seek the guidance of a qualified expert or licensed professional with any questions or concerns you may have.
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