Based on NIH | Is it true that only people who drink alcohol get fatty liver disease?

No fatty liver disease can happen with or without alcohol use. There are two main types: alcoholic fatty liver disease (from heavy drinking) and nonalcoholic fatty liver disease (NAFLD), which occurs in people who do not drink heavily. ^{[1] [2]} Alcohol can clearly lead to fat buildup and liver injury, but many people develop fatty liver due to metabolic factors such as obesity, type 2 diabetes, and high triglycerides, even if they consume little or no alcohol. ^{[1] [2]}

What “fatty liver” means

Fatty liver means excess fat is stored in liver cells. Both alcoholic and nonalcoholic forms range from simple fat (steatosis) to inflammation and injury (steatohepatitis), which can progress to scarring (cirrhosis) and, rarely, liver cancer. ^{[1] [3]} In NAFLD, the severe inflammatory form is called nonalcoholic steatohepatitis (NASH). ^[3] NAFLD is now one of the most common liver conditions worldwide. ^[3]

Two main types and how they differ

• Alcoholic fatty liver disease (ALD): Heavy alcohol intake overwhelms the liver’s ability to process alcohol, leading to fat buildup and potential injury. Stopping alcohol can often improve early disease. ^[4]
• Nonalcoholic fatty liver disease (NAFLD): Fat builds up in people who do not drink excessively, commonly linked to obesity, diabetes, insulin resistance, and abnormal blood lipids. ^{[5] [1]} Some people develop NAFLD even without these risks, but metabolic factors are most common. ^{[2] [6]}

Key risk factors beyond alcohol

• Excess body weight and central obesity are strong drivers of NAFLD. ^[7]
• Prediabetes/Type 2 diabetes and insulin resistance increase risk. ^[7]
• High triglycerides or cholesterol and features of metabolic syndrome are closely tied to NAFLD. ^{[5] [8]}
• Age, certain hormones (e.g., hypopituitarism), and genetics can also play roles. ^{[6] [8]}
• Overlap happens: Some people have both metabolic risks and drink alcohol, and combined risks can worsen outcomes. ^{[9] [10]}

Shared disease pathway

Although causes differ, alcoholic and nonalcoholic fatty liver diseases share similar patterns from fat accumulation to inflammation, scarring, and complications and involve overlapping biological processes such as oxidative stress and inflammatory signaling. ^[11] This explains why both forms can lead to similar long‑term liver damage if not addressed. ^{[3] [1]}

Common symptoms and detection

Most people with fatty liver have no symptoms early on. Fatty liver is often found because of mild liver enzyme elevations or on imaging (like ultrasound) done for other reasons. ^[1] Because NAFLD is common in people with metabolic risks, clinicians often screen those groups. ^[1]

What you can do

• Limit or avoid alcohol if there is any concern for liver disease; even in metabolic fatty liver, alcohol can add risk. ^[1]
• Achieve and maintain a healthy weight through balanced diet and regular exercise; even 5–10% weight loss may reduce liver fat and inflammation. ^{[12] [13]}
• Control blood sugar, blood pressure, and lipids with lifestyle and medications as advised. ^[7]
• Use medicines properly and review any that might affect the liver with your clinician. ^[12]
• Regular follow‑up is important, because some people progress from simple fat to inflammation and scarring. ^{[2] [3]}

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Quick comparison at a glance

Feature	Alcoholic fatty liver disease	Nonalcoholic fatty liver disease (NAFLD)
Main driver	Heavy alcohol use	Metabolic factors (obesity, insulin resistance, diabetes, high triglycerides)
Alcohol exposure	Excessive	Little or none
Disease spectrum	Steatosis → alcoholic hepatitis → cirrhosis	Simple steatosis → NASH → fibrosis/cirrhosis
Overlap with other risks	May coexist with obesity/diabetes	May be worsened by any alcohol use
Key action	Abstain from alcohol	Weight loss, diet, exercise, manage metabolic risks

Alcohol is not the only cause of fatty liver disease many people who drink little or no alcohol can still develop fatty liver due to metabolic health factors, and both forms can be serious without early management. ^{[1] [2] [3]}