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Fatty liver is present in a large proportion of Indian patients with obesity, and it is usually found by accident. Two calculations from a routine report you probably already have will tell you whether it matters, and whether it needs a specialist.
Everything here is on a standard liver function test and a complete blood count. If your report gives SGOT and SGPT, those are the same as AST and ALT in that order. The boxes start with example numbers. Replace them with the ones on your report.
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The two questions are different, and only one of them changes what happens next.
Is there fat in the liver? For most people arriving at an obesity clinic, the answer is probably yes, and knowing it changes very little on its own. That is what the Hepatic Steatosis Index answers.
Is the liver scarred? That is the question that matters, because scarring, which doctors call fibrosis, is what eventually causes harm, and because it changes whether you need a liver specialist. That is FIB-4, and it is the first step in both the American and European liver guidelines.
Normal liver enzymes do not exclude liver disease. This surprises people and it is worth stating plainly. A substantial proportion of people with significant fatty liver disease have completely normal ALT and AST. That is precisely why a calculation that combines several values outperforms looking at the enzymes alone, and why "my LFTs are normal" is not the reassurance it sounds like.
There is no tablet that reliably clears fat from the liver. Weight loss does, and the relationship is strikingly steep. In a study of 293 people with biopsy-proven liver inflammation, followed with repeat biopsies after a year of lifestyle change, resolution of the inflammation rose sharply with the amount of weight lost, and at 10 per cent or more it was reached by about 90 per cent of participants, with scarring actually regressing in about 45 per cent. The what it buys tool lays those bands out.
That study was done in Cuba, not India, and Indians develop liver fat at a lower body weight, so treat the bands as a direction of travel rather than a promise.
What this is and is not. This is a published screening tool, reproduced with its source named so you or any doctor can check it. It is not a diagnosis and it is not monitored by a person. Nobody at the clinic sees your answers. If your report is more than six months old, repeat it before drawing conclusions.
FIB-4: Sterling RK and colleagues, Hepatology 2006;43:1317-1325, with the age 65 adjustment from McPherson S and colleagues, American Journal of Gastroenterology 2017;112:740-751. Hepatic Steatosis Index: Lee JH and colleagues, Digestive and Liver Disease 2010;42:503-508, derived and validated in 10,724 adults. Weight loss and liver histology: Vilar-Gomez E and colleagues, Gastroenterology 2015;149:367-378.
Every number here comes from a named, published clinical trial and is reported as what happened to the people in that trial. None of it is a result from this clinic, a prediction for you, or a promise. Trial populations are selected and individual results vary widely. The trials are named in the reference line above so that you, or any doctor, can look them up.
If you want to talk about what any of it means for your own situation, our contact details and consulting hours are at the bottom of every page in this section, and our fees are published in full on the cost page.