There is no one cause of steatotic liver disease (SLD). It usually develops over a long period of time and is usually caused by a combination of factors such as: 

• eating a diet high in processed foods, saturated fat and added sugars 
• not enough exercise or movement 
• excess weight. 

Over time, these can lead to problems with your metabolism, including insulin resistance, metabolic syndrome and a poor gut microbiome (the bacteria in your gut). ^xii

All of these increase your risk for steatotic liver disease. 

In Australia, rates of steatotic liver disease have risen over the past 15 years.^xiii

Having problems with your metabolism may increase your risk for some health conditions, including steatotic liver disease. 

What is metabolism? 

Metabolism refers to the chemical (metabolic) processes that happen in your body to keep it working properly.^xiv Metabolism is a complex process where your body changes what you eat and drink into energy your body can use for basic functions. These include:  

• breathing 
• circulating blood 
• digesting food 
• growing and repairing cells 
• maintaining hormone levels 
• regulating body temperature. 

Insulin resistance 

One of the main drivers of steatotic liver disease is insulin resistance.xv Insulin is a hormone that acts as a key to allow glucose to leave the bloodstream and enter our cells to be used for energy.xvi Insulin resistance occurs when insulin doesn’t work effectively so the body makes more. 

Eating processed foods high in saturated fat and sugar, not getting enough exercise, weight gain, poor sleep and stress all contribute to insulin resistance. 

Over time, this can lead to other health problems such as high cholesterol and triglycerides (fat in the blood), high blood pressure, and visceral fat (fat around your organs).  

Insulin resistance commonly occurs with other conditions. When someone is diagnosed with three or more of these other conditions, it’s known as metabolic syndrome. 

Metabolic syndrome 

Metabolic syndrome is a group of conditions that often occur together and increase your risk for health conditions such as heart disease, diabetes, cancer, and liver steatosis. You may have metabolic syndrome if you have three of more of the following^xvii: 

• excess weight around the stomach (a waist circumference of more than 80 cm for women and 94 cm for men*) 
• high blood pressure (hypertension) 
• high blood sugar levels or diabetes (insulin resistance) 
• high triglycerides (a type of fat in your blood) 
• high ‘bad’ cholesterol (LDL cholesterol) 
• low ‘good’ cholesterol (HDL cholesterol) 

* Please note that the suggested waist measurements above are general guidelines and may not be accurate for all cultural groups. Healthy waist measurements can vary amongst different ethnic groups, for example Aboriginal and Torres Strait Islanders and people of Asian descent. They may also be different in situations such as pregnancy or if you have another medical condition. Ask your doctor what a healthy waist measurement should be for you.  

Learn about waist measurements for different ethnic groups. 

Around 30% of people in Australia have metabolic syndrome and more than half have at least one of the conditions listed above.^xviii

Steatotic liver disease caused by metabolic factors such as these is known as Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD). 

Gut health and steatotic liver disease 

Trillions of bacteria and other micro-organisms live inside your gut and play an important role in your overall health. Gut bacteria is also called your gut microbiome, or gut flora. 

Gut health is important because it influences our body’s metabolism. A healthy gut helps our body work properly and helps keep us healthy. Poor gut health has been linked to many health conditions, including steatotic liver disease.^xix

The health of our gut microbiome depends on what we eat. If we eat a diet rich in a wide variety of fruits and vegetables, good gut bacteria can thrive and grow. However, eating processed foods high in saturated fat and sugar leads to poor gut health, and increases the risk for steatotic liver disease. 

Drinking too much alcohol also increases your risk for liver steatosis. You are at risk if you drink:

more than 10 standard drinks a week, or more than four standard drinks in a day (binge drinking),

* Please note that in Australia a ‘standard drink’ refers to 10 grams of alcohol. ^xx ‘Recommended standard drinks’ are a guideline and may not reflect the best advice based on your age, gender or ethnicity.

More than five million people in Australia have a fatty liver caused by alcohol. ^xxi Women are also more at risk of developing steatotic liver disease through alcohol consumption than men.

If you have MASLD and drink large quantities of alcohol, both metabolic factors and alcohol consumption contribute to fat buildup in your liver. This is known as MASLD with increased alcohol intake (MetALD).

While most cases of steatotic liver disease are linked to excess weight and other metabolic factors, you can still develop SLD if you have a healthy weight. Around 40% of people with liver steatosis are not overweight. ^xxii

Health conditions linked to SLD 

Other health conditions may increase your risk for liver steatosis.^xxiii These include:

• family history of steatotic liver disease 
• family history of obesity 
• diabetes 
• polycystic ovary syndrome (PCOS) 
• obstructive sleep apnoea 
• underactive thyroid (hypothyroidism) 
• overactive thyroid (hyperthyroidism). 

If you’re concerned about your risk for steatotic liver disease, talk to your doctor. 

Medications and SLD 

Part of the liver’s function is to break down any substances you consume so that your body can use them. That means your liver also processes any medication you take. Some medications may cause strain on your liver. Your GP will let you know if you need to stop or change any medication you may be taking. You can also talk to them if you have any concerns or questions.  

Other risk factors 

Steatotic liver disease is more common in people over the age of 50. However, younger people, including children, can also develop the condition. 

The more risk factors you have the quicker liver steatosis will get worse. You’ll also have a higher risk of developing serious liver problems.  

Action: 

Ask your doctor to check your metabolic risk factors for SLD such as blood pressure, blood glucose levels and cholesterol levels. 

Talk to your doctor about your risk for other health conditions linked to SLD, such as PCOS or thyroid problems.