Lifestyle
6 Signs of Fatty Liver Disease Most People Miss
By Erica Coleman · October 16, 2026
Most people learn they have fatty liver disease by accident. A routine blood test comes back slightly off, or a scan ordered for something else shows more fat in the liver than there should be. Cleveland Clinic says providers often find steatotic liver disease during routine tests for other conditions.
The name has changed, too. What doctors long called nonalcoholic fatty liver disease, or NAFLD, is now also called metabolic dysfunction-associated steatotic liver disease, or MASLD. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that about 24% of U.S. adults have NAFLD, and it says people are more likely to develop it as they age.
It is also quiet. NIDDK calls it a silent disease with few or no symptoms, even in some people whose disease has progressed to cirrhosis. So the signs below are a mix of things you might feel and things that only show up on paper. None of them proves you have it. Several together are worth bringing up at your next checkup.
Tiredness you can’t explain. When fatty liver does cause symptoms, NIDDK says you may feel tired. That one is easy to blame on bad sleep or a long week. Cleveland Clinic also lists weakness and unexplained weight loss among the early symptoms some people notice.
A dull ache under your right ribs. The other symptom NIDDK names is discomfort in the upper right side of your abdomen, where the liver sits. Even the milder form can do this. NIDDK notes that simple fatty liver can cause pain from enlargement of the liver.
A liver enzyme flag on your bloodwork. Two liver enzymes, ALT and AST, are measured with a blood test. NIDDK says your doctor may suspect you have NAFLD if your blood test shows increased levels of them. Doctors can also use routine blood results to calculate scores such as FIB-4, which help rule advanced scarring in or out. If a high ALT shows up on more than one checkup, ask what is behind it.
A bigger waist and a few borderline numbers. NIDDK ties fatty liver to metabolic syndrome, which doctors diagnose when you have any three of these: large waist size, high triglycerides, low HDL cholesterol, high blood pressure, and higher than normal blood glucose or type 2 diabetes. The diabetes link is strong. NIDDK cites studies suggesting one-third to two-thirds of people with type 2 diabetes have NAFLD.
Darkened skin over your knuckles, elbows or knees. During an exam, NIDDK says doctors look for signs of insulin resistance, such as darkened skin patches over your knuckles, elbows, and knees. Insulin resistance is one of the conditions that makes fatty liver more likely. Few people would connect a patch of darker skin on an elbow to their liver.
Swelling or yellowing. These usually mean the disease has gone further. Cleveland Clinic lists yellowing of your skin or the whites of your eyes, swelling in your belly and swelling in your legs as symptoms that can appear as it gets worse, along with confusion. For cirrhosis, NIDDK warns that symptoms may not appear until the liver is badly damaged. Do not wait on these.
There is real reason to act early. Cleveland Clinic says steatosis is often reversible, especially in the early stages and before cirrhosis develops. Treatment focuses on gradual weight loss if needed, at least 30 minutes of activity a day, managing diabetes and blood fats, and limiting alcohol. The FDA approved new medicines for liver scarring and inflammation in 2024 and 2025. If you have type 2 diabetes or carry extra weight, Cleveland Clinic says regular checkups can help catch problems early.
This article is for general information and is not medical advice. If you have risk factors for fatty liver disease or an abnormal liver test result, talk with your doctor about whether more testing makes sense for you.