Lifestyle

Doctors Say a Third of US Adults Have This and Don’t Know It

By Erica Coleman · July 11, 2026

“There are an awful lot of people walking around with liver disease, and most of them don’t know it.”

Dr. Matt Cave, a liver specialist at the University of Louisville, said that’s the defining trait of fatty liver disease: it rarely announces itself. About one-third of U.S. adults have nonalcoholic fatty liver disease, according to Dr. Rohit Loomba, a liver disease expert at UC San Diego Health — and most feel completely normal.

That’s the problem. Unlike a heart attack or a broken bone, liver disease tends to whisper instead of shout, and the whisper usually sounds like something else entirely: being tired. Here’s what doctors say is actually worth paying attention to.

Fatigue that doesn’t improve with rest. This is the most commonly reported symptom, and also the easiest to write off. The liver plays a central role in regulating energy, so when it’s under strain, exhaustion can set in even after a full night’s sleep. The distinction that matters: normal tiredness responds to rest. Liver-related fatigue tends to linger regardless of how much sleep you get.

Mild discomfort in the upper right abdomen. NIH News in Health notes that when symptoms of fatty liver disease do appear, discomfort in the upper right side of the abdomen is one of the most common, since that’s roughly where the liver sits. It’s typically described as a dull, heavy feeling rather than sharp pain, which is part of why people tend to dismiss it.

Yellowing of the skin or eyes. Jaundice happens when the liver can’t properly process bilirubin, a byproduct of old red blood cells, and it builds up in the bloodstream instead. This tends to show up later in the disease’s progression, but it’s one of the clearest visible signs that the liver is struggling — and it should prompt a same-week doctor’s visit, not a wait-and-see approach.

Swelling in the belly or legs. As liver function declines, the organ becomes less able to produce proteins that regulate fluid balance. That can lead to noticeable swelling, particularly in the abdomen or lower legs, that doesn’t have an obvious other explanation like an injury or long flight.

Unexplained bruising or slow healing. The liver produces the proteins responsible for blood clotting. When it’s compromised, people may notice they bruise more easily than usual or that small cuts take longer to stop bleeding.

Persistent itching without a rash. This one surprises people. When bile salts build up in the bloodstream due to impaired liver function, they can irritate nerve endings in the skin, causing itching with no visible cause. It’s often misattributed to dry skin or allergies.

Roughly 70% to 80% of people who are overweight or living with obesity have some degree of fatty liver, and the rate climbs even higher among people with type 2 diabetes. But Loomba and other researchers are quick to note the disease isn’t limited to people who fit that profile — genetics, certain medications, and even long-term chemical exposure can play a role.

The good news doctors emphasize is that early-stage fatty liver is often reversible. Weight loss, even a modest amount, is consistently cited as the most effective intervention. What isn’t reversible is the scarring that develops once the disease progresses to cirrhosis — which is exactly why catching it early, before symptoms become impossible to ignore, matters as much as it does.

If persistent fatigue doesn’t have an obvious cause, doctors say it’s worth asking for a liver enzyme test at your next physical. It’s a simple blood draw, and for a disease this common and this quiet, it may be the only warning you get.