What are 5 signs of a fatty liver?

Fatty liver disease is common, often silent, and increasingly seen in people of all ages. This article explains what fatty liver is, why it matters, and how to recognize early warning signs before complications develop. You’ll learn the five most common signs associated with a fatty liver, how those signs relate to liver health indicators, and why symptoms alone rarely reveal the full picture. We also walk through medical evaluation, lifestyle factors, and the evidence behind select nutritional supplements that may support liver health as part of a comprehensive plan. The goal is to help you understand your options and take informed, responsible steps toward better liver health.

Understanding Fatty Liver: A Growing Health Concern

Fatty liver, also called hepatic steatosis, occurs when excess fat accumulates in liver cells. While the liver normally contains small amounts of fat, fat buildup beyond roughly 5% of liver weight can disrupt its many vital functions—processing nutrients, regulating blood sugar and lipids, filtering toxins, and producing essential proteins. The condition is common and rising worldwide, paralleling increases in obesity, diabetes, and sedentary lifestyles. Many individuals discover fatty liver incidentally on imaging or routine blood work, long before symptoms appear.

Early detection matters. When identified and addressed early, fatty liver can often be improved with targeted lifestyle measures and, in some cases, adjunctive nutritional support. Recognizing early fatty liver signs and “clues” can prompt a timely conversation with a clinician and a personalized plan to protect long-term health.

Core Explanation of Fatty Liver

What is Nonalcoholic Fatty Liver Disease (NAFLD)?

Nonalcoholic fatty liver disease (NAFLD) refers to excess fat in the liver in people who consume little or no alcohol. It spans a spectrum. At the mild end is simple steatosis (fat accumulation without significant inflammation). At the more serious end is nonalcoholic steatohepatitis (NASH), in which fat buildup is accompanied by liver cell injury and inflammation. Over time, some individuals with NASH can develop fibrosis (scar tissue), which can progress to cirrhosis and liver-related complications.

Why does fat accrue in the liver? A central driver is insulin resistance—when cells in muscle, fat tissue, and the liver respond less effectively to insulin. Insulin resistance promotes increased fat delivery to the liver from the bloodstream, increased “de novo lipogenesis” (the liver converting excess carbohydrate, especially fructose, into fat), and impaired fat export. As fat accumulates, some lipid species can become toxic to cells (lipotoxicity), increasing oxidative stress and inflammatory signaling. In genetically susceptible individuals, these processes can accelerate, increasing the risk of fibrosis.

NAFLD is distinct from alcohol-associated fatty liver disease (AFLD), where alcohol plays a primary role. That said, even modest alcohol intake can add metabolic stress in people with NAFLD, so your clinician will usually discuss a safe approach to alcohol based on your personal health profile.

Liver Health Indicators and Their Significance

The liver performs hundreds of biochemical tasks, so clinicians often rely on a combination of blood tests and imaging tools—“liver health indicators”—to evaluate it. Common blood markers include ALT and AST (liver enzymes), GGT, alkaline phosphatase, bilirubin, albumin, platelets, and sometimes markers of inflammation and insulin resistance (glucose, A1C, triglycerides, HDL-cholesterol, fasting insulin). While elevated ALT or AST can happen in fatty liver, many people with hepatic steatosis have normal enzymes; normal blood tests do not rule out fatty liver.

Imaging is frequently used to screen for or confirm excess liver fat. Ultrasound is widely available; transient elastography (FibroScan) adds measurements of liver stiffness and fat content; MRI-based methods (such as MRI-PDFF) provide more precise quantification of liver fat. In certain situations, a liver biopsy remains the gold standard to diagnose NASH and assess the degree of fibrosis, but it’s not required for everyone.

Why This Topic Matters

Health Implications of Untreated Fatty Liver

Left unaddressed, fatty liver can progress for years without clear symptoms, increasing the risk of NASH, fibrosis, and cirrhosis. Importantly, NAFLD is strongly associated with cardiometabolic disease: type 2 diabetes, dyslipidemia (high triglycerides and/or low HDL), hypertension, and a higher risk of cardiovascular events. Among the potential long-term consequences, cardiovascular disease often poses the greatest immediate risk. In daily life, the condition may also affect energy, mood, and overall quality of life—especially when compounded by sleep disturbance, stress, or other chronic conditions.

The encouraging news is that fatty liver is dynamic: weight loss, dietary changes, physical activity, and targeted medical care can reduce liver fat and improve markers of inflammation and fibrosis. Early attention can have substantial, lasting benefits.

Recognizing Fatty Liver: 5 Key Signs You Should Know

Most people with fatty liver feel well, especially in early stages. Even so, certain patterns recur often enough to serve as practical signposts. These are not diagnostic on their own, and they overlap with other conditions. Use them as cues to speak with a healthcare professional and explore appropriate testing.

• 1) Persistent fatigue or low energy
  Many people with hepatic steatosis describe lethargy or “energy dips,” especially in the afternoon. The mechanisms are multifactorial: insulin resistance, sleep apnea (common in metabolic syndrome), low-grade inflammation, and altered mitochondrial function in liver cells may contribute. While fatigue has many causes, its coexistence with metabolic risk factors can raise suspicion for fatty liver.
• 2) Mild discomfort in the upper-right abdomen
  A sense of fullness, pressure, or dull ache under the right ribcage (where the liver sits) can occur when the liver is enlarged. The sensation is typically mild and intermittent rather than sharp or severe. Intense pain, fever, or jaundice are not typical of uncomplicated fatty liver and should prompt urgent evaluation for other causes.
• 3) Unexplained weight gain or difficulty losing weight
  Insulin resistance favors fat storage—especially around the waist—and can make weight loss more challenging. People often notice central weight gain and increasing waist circumference despite similar eating habits. While weight change is not a symptom of the liver per se, it often travels with the metabolic profile that predisposes to hepatic steatosis.
• 4) Elevated liver enzymes on routine blood tests
  Mild elevations in ALT and/or AST can be an early sign. However, many individuals with fatty liver have normal liver enzymes, and elevated enzymes can result from many conditions. Think of ALT/AST as helpful, but imperfect, liver health indicators that need context and follow-up.
• 5) Incidental finding of liver fat on imaging
  Steatosis is frequently identified during ultrasound or other imaging performed for unrelated reasons. While not a “symptom,” this is a clinically important sign that warrants evaluation of metabolic risk and potential fibrosis using noninvasive scores or elastography.

Related Symptoms and Liver Health Indicators

Beyond the five signs above, several subtle nonalcoholic fatty liver clues can strengthen suspicion, especially when seen together:

• Increased waist circumference or central adiposity
• Elevated triglycerides and/or low HDL-cholesterol
• Prediabetes or type 2 diabetes (elevated fasting glucose or A1C)
• Acanthosis nigricans (darkened, velvety skin in body folds), a marker of insulin resistance
• Obstructive sleep apnea symptoms (snoring, non-restorative sleep)
• Polycystic ovary syndrome (PCOS) in women, which often includes insulin resistance

These features are not diagnostic but help clinicians assess risk and prioritize further testing. In practice, a combination of symptoms, lab results, and imaging findings leads to a confident liver fat diagnosis and risk stratification for fibrosis.

Why Symptoms Alone Do Not Reveal the Root Cause

Limitations of Relying Solely on Symptoms

Fatty liver is often asymptomatic, and its symptoms—when present—are nonspecific. Fatigue, mild abdominal discomfort, or weight changes can arise from countless other conditions. Normal liver enzymes do not guarantee a healthy liver, just as modest elevations do not prove fatty liver is the only issue. Relying on symptoms alone invites guesswork and may delay effective action.

The Necessity of Medical Assessment and Liver Health Indicators

A comprehensive evaluation clarifies root causes. Clinicians typically review alcohol intake, medications, viral hepatitis status, autoimmune and genetic conditions, family history, and metabolic health. They may order bloodwork (ALT, AST, GGT, bilirubin, albumin, platelets, lipids, glucose, A1C) and recommend imaging (ultrasound or elastography). Noninvasive fibrosis scores (e.g., FIB-4, NAFLD Fibrosis Score) help identify who may need specialist referral or advanced testing. In select cases, a biopsy confirms the presence of NASH and guides treatment decisions. This structured approach moves beyond symptoms to a more precise view of liver health and future risk.

The Biology Behind Fatty Liver—and Why Risk Varies

Individual biology shapes how and why fatty liver develops. Insulin resistance increases fatty acid flux to the liver and stimulates de novo lipogenesis, especially with high intake of refined carbohydrates and fructose-sweetened beverages. Mitochondrial stress and oxidative damage can injure liver cells, triggering inflammatory pathways. The gut-liver axis also matters: alterations in the microbiome may influence intestinal permeability and inflammatory signaling. Meanwhile, genetics (e.g., PNPLA3, TM6SF2 variants) can raise susceptibility even in people without obesity.

Because contributors differ from person to person—dietary patterns, sleep quality, physical activity, stress levels, medications, and genetics—effective strategies are personalized. Two people can have similar symptoms but very different underlying drivers. This variability underscores why a one-size-fits-all plan or a “symptom-only” approach rarely works well.

Nutrition and Lifestyle: The Foundation of Care

Across professional guidelines, lifestyle optimization is the cornerstone of fatty liver management. For many, a sustained calorie deficit leading to 7–10% weight loss can reduce liver fat and improve markers of inflammation and fibrosis. Improvements often begin at more modest weight loss (3–5%). A Mediterranean-style eating pattern—rich in vegetables, legumes, whole grains, nuts, olive oil, fish, and modestly lower in refined starches and added sugars—has been associated with reduced liver fat. Reducing sugar-sweetened beverages and refined carbohydrates can decrease de novo lipogenesis. Adequate protein supports satiety and lean mass during weight loss.

Physical activity is equally important. Aim for 150–300 minutes per week of moderate aerobic activity, plus resistance training two or more days per week. Exercise can reduce liver fat even without major weight loss by improving insulin sensitivity and muscle glucose uptake. Consistent sleep (7–9 hours for most adults), good sleep apnea management if present, stress reduction, and avoidance of unnecessary alcohol round out a comprehensive plan. Many people need structured support and follow-up to make durable changes—considering behavioral coaching, group programs, or digital tools.

The Role of Nutritional Supplements in Managing Fatty Liver

Nutritional Supplements as a Complementary Approach

Supplements are not cures for fatty liver, but certain options may complement diet, exercise, and medical care by supporting metabolic and antioxidant pathways. Effects can be modest and vary widely between individuals. Quality matters, and potential interactions should always be considered. The goal is to align supplement choices with your specific liver health indicators, metabolic profile, and clinician guidance.

Evidence-Based Supplements That May Help Reduce Liver Fat and Inflammation

• Omega-3 fatty acids (EPA/DHA): Marine omega-3s can reduce triglycerides and, in several studies, modestly lower liver fat measured by imaging. They may help re-balance lipid metabolism and dampen inflammatory signaling. Benefits appear strongest for hypertriglyceridemia and steatosis; their impact on NASH histology is less certain. Consider discussing an omega-3 supplement if your triglycerides are elevated or if your clinician recommends one. Explore options here: high-quality EPA/DHA choices.
• Vitamin E (alpha-tocopherol): In select clinical trials, 800 IU/day improved liver histology in non-diabetic adults with biopsy-proven NASH. However, it is not universally recommended for all patients due to potential risks (e.g., bleeding, and mixed evidence regarding prostate health). If considered, it should be used under medical supervision and tailored to individual risk-benefit profiles.
• N-acetylcysteine (NAC): As a precursor to glutathione, a key antioxidant in the liver, NAC may reduce oxidative stress. Small studies suggest improvements in liver enzymes and inflammatory markers when used alongside lifestyle measures. Dosing and duration should be individualized.
• Milk thistle (silymarin): Silymarin has antioxidant and membrane-stabilizing properties. Evidence for fatty liver is mixed; some trials show small reductions in ALT/AST and potential anti-inflammatory effects. Product standardization and dose vary. Consider it an adjunct rather than a standalone solution.
• Curcumin: The primary active component of turmeric may reduce inflammatory signaling and oxidative stress. Some small studies report improvements in liver enzymes and steatosis indices. Bioavailability-enhanced formulations (e.g., with piperine or phytosome technology) are typically used in research settings.
• Licorice extract (glycyrrhizin): May have anti-inflammatory effects in the liver. Caution is warranted due to the potential for elevated blood pressure, low potassium, and interactions with certain medications, especially with chronic use.
• Vitamin D: Deficiency is common in metabolic syndrome, and observational studies link low vitamin D to NAFLD. Interventional data are mixed; some research shows improvements in metabolic markers, while effects on liver histology remain uncertain. Assess your status and correct deficiency as advised by your clinician. Learn more about forms, dosing, and safety here: vitamin D guidance.
• Choline: Essential for VLDL particle production that exports fat from the liver. Severe deficiency can produce steatosis. Most people obtain adequate choline from diet (eggs, lean meats, legumes), but some may benefit from assessing intake—particularly vegans, certain genetic variants, or during pregnancy (seek medical guidance).
• Berberine: This plant alkaloid may improve insulin sensitivity and lipid profiles. Early studies show promise for reducing liver fat and improving glycemic control. Watch for gastrointestinal side effects and potential drug interactions.
• Probiotics and synbiotics: Modulating the gut microbiota may influence the gut-liver axis. Some trials suggest improvements in liver enzymes and steatosis scores, though strains and dosing vary.
• Vitamin C and other antioxidants: Vitamin C participates in antioxidant defense and collagen synthesis. While it is not a treatment for fatty liver, maintaining adequate antioxidant status supports overall hepatic resilience. See options and formulations here: vitamin C choices.
• Magnesium: Low magnesium intake has been linked to insulin resistance and systemic inflammation. Supplementation may support glucose metabolism and sleep quality—helpful in a metabolic context. For more on forms and benefits, see: magnesium insights.

Note: Some individuals inquire about vitamin K due to its roles in coagulation and bone health; while early research explores its effects in metabolic settings, consistent benefits for fatty liver require more evidence. Address nutrient gaps based on dietary assessment and lab data whenever possible. If you take anticoagulants or other medications, discuss vitamin K and any supplement changes with your clinician.

Who Should Consider Nutritional Supplements?

Identifying Individuals at Risk or With Early Signs

Supplements may be considered when they directly address your specific risk profile and complement foundational measures. People most likely to benefit include those with:

• Metabolic syndrome, obesity, or prediabetes/type 2 diabetes
• Elevated liver enzymes or imaging evidence of steatosis
• High triglycerides or low HDL-cholesterol
• Dietary gaps (e.g., low omega-3 intake, low choline, low vitamin D)
• Nonalcoholic fatty liver clues plus fatigue or sleep issues that impede lifestyle progress

When Supplements Are Recommended

Supplements typically make the most sense when integrated into a comprehensive plan that includes nutrition, activity, sleep, and medical follow-up. Consider them when:

• Foundational diet and exercise changes are underway, and targeted support may enhance adherence or metabolic response
• Blood tests reveal nutrient deficiencies or risk patterns (e.g., low vitamin D, high triglycerides)
• Your clinician recommends specific evidence-based options (e.g., omega-3s for hypertriglyceridemia)

Always inform your healthcare provider about any supplements you take, especially if you use prescription medications, have chronic conditions, or are pregnant or breastfeeding.

Decision-Support: When Do Nutritional Supplements Make Sense?

Assessing Readiness for Supplementation

Before starting supplements, clarify your goals and baseline status. What do your liver health indicators show—enzymes, lipid profile, A1C, imaging? Are you ready to make, or have you already made, meaningful diet and activity changes? Are sleep and stress addressed? Supplements can be catalysts, but they work best when the underlying environment—nutrition, movement, sleep—is supportive.

Integrating Supplements With Lifestyle Changes

To build a practical, sustainable plan:

• Prioritize consistent meal patterns: minimally processed foods, high fiber, lean protein, and healthy fats
• Limit refined carbohydrates, sugar-sweetened beverages, and excess alcohol
• Schedule regular physical activity and track steps or workouts
• Address sleep habits and evaluate for sleep apnea if symptoms exist
• Introduce one supplement at a time, monitor how you feel, and track objective markers (e.g., triglycerides, ALT/AST)

Consulting Healthcare Professionals

Discuss your plan with a clinician, dietitian, or pharmacologist—especially if you have coexisting conditions such as diabetes, kidney disease, or cardiovascular disease. They can help select appropriate doses, watch for interactions, and schedule follow-up labs or imaging. A personalized approach maximizes safety, aligns with scientific evidence, and improves the chance of durable benefits.

How Clinicians Diagnose and Monitor Fatty Liver

A typical evaluation may include:

• History and exam: Alcohol intake, medications and supplements, family history, metabolic risk, sleep patterns
• Blood tests: ALT, AST, GGT, alkaline phosphatase, bilirubin, albumin, platelets, lipid profile, glucose, A1C; sometimes viral hepatitis screens or autoimmune panels
• Imaging: Ultrasound for steatosis screening; transient elastography for fat content and liver stiffness; MRI-based methods for precise fat quantification
• Noninvasive fibrosis scores: FIB-4, NAFLD Fibrosis Score to identify those who may need specialist referral
• Liver biopsy: Reserved for select cases where NASH or advanced fibrosis is suspected and will change management

Follow-up typically includes periodic labs, metabolic monitoring (A1C, triglycerides, HDL, waist circumference), and in some cases repeat imaging or elastography. Your clinician may also review blood pressure, kidney function, and sleep health, given their frequent overlap with fatty liver.

Safety, Interactions, and Setting Realistic Expectations

Even natural products can interact with medications or preexisting conditions. Vitamin E at high doses may increase bleeding risk. Licorice extracts can raise blood pressure and lower potassium. Omega-3s can influence bleeding time when combined with anticoagulants (though typical doses are generally considered safe with monitoring). Curcumin may interact with anticoagulants and antiplatelets. Berberine can affect cytochrome P450 enzymes and P-glycoprotein, potentially altering drug levels. Always review your full medication and supplement list with a healthcare professional.

Set expectations around timing and magnitude of change. Many people notice improvements in energy, triglycerides, or liver enzymes over 8–24 weeks when combining lifestyle measures with targeted supplementation. Imaging changes in liver fat may take months. Fibrosis, if present, typically requires sustained interventions over longer periods. Supplements should be seen as supportive tools, not quick fixes.

Special Considerations: Different Populations

• People with type 2 diabetes: NAFLD is highly prevalent; GLP-1 receptor agonists and SGLT2 inhibitors, prescribed for diabetes, can aid weight loss and improve metabolic parameters with potential liver benefits. Coordinate supplement choices with the diabetes care team.
• Lean NAFLD: Some people develop fatty liver without obesity. Genetics, visceral fat distribution, dietary patterns, and gut microbiota may contribute. The same principles—personalized diet, activity, and careful evaluation—apply.
• Children and adolescents: NAFLD is increasing in youth. Any supplement plan requires pediatric guidance. Lifestyle, family-based nutrition changes, and sleep remain central.
• Pregnancy: Unique liver disorders can occur. Avoid nonessential supplements and always consult obstetric providers before any changes.
• Alcohol intake: Even modest amounts can aggravate liver stress for some individuals with NAFLD. Discuss safe limits with your clinician.

Practical Tips for Day-to-Day Progress

• Anchor meals around vegetables, legumes, lean proteins, and high-fiber carbohydrates
• Swap sugary drinks for water, sparkling water, or unsweetened tea/coffee
• Include fatty fish (e.g., salmon, sardines) several times per week or consider omega-3s if intake is low
• Prioritize sleep consistency; evaluate snoring or daytime sleepiness with your clinician
• Start with manageable exercise goals: a brisk 20–30 minute walk most days, plus basic resistance exercises
• Track a few key metrics: waist circumference, steps, and a small set of labs chosen with your clinician
• Introduce supplements thoughtfully and reassess every 8–12 weeks

Key Takeaways

• Fatty liver is common and often silent; early recognition and assessment can prevent complications.
• The five key signs are fatigue, mild right-upper abdominal discomfort, weight challenges (especially central gain), elevated liver enzymes, and incidental imaging findings of steatosis.
• Symptoms alone are unreliable; liver health indicators (blood tests, imaging, noninvasive scores) are essential for accurate risk assessment.
• Lifestyle change—weight management, diet quality, physical activity, sleep—is the cornerstone of care.
• Supplements such as omega-3s, vitamin E (in select cases), NAC, silymarin, curcumin, and magnesium may offer supportive benefits when used responsibly.
• Personalized plans work best; individual biology and comorbidities shape what helps most.
• Set realistic expectations; improvements often take weeks to months and require consistency.
• Work with healthcare professionals to integrate testing, lifestyle, and any supplements safely.

Frequently Asked Questions

1) Can fatty liver be reversed?

In many cases, yes. Reducing liver fat through weight loss, dietary changes, and physical activity can improve liver enzymes and imaging findings. If fibrosis has developed, sustained lifestyle changes may stabilize or partially regress scarring, but timing and outcomes vary by individual.

2) What’s the difference between NAFLD and NASH?

NAFLD refers to fat accumulation in the liver in people who drink little or no alcohol. NASH is a more severe form that adds inflammation and liver cell injury on top of fat. NASH carries a higher risk of fibrosis and long-term complications, making early detection and management important.

3) Which diet is best for fatty liver?

A Mediterranean-style pattern with emphasis on whole foods, high fiber, and healthy fats is well supported. Limiting refined carbohydrates and sugar-sweetened beverages is key. Ultimately, the “best” diet is one you can sustain that reliably reduces excess calorie intake and improves metabolic health.

4) Do supplements cure fatty liver?

No. Supplements can support metabolic and antioxidant pathways but are not cures. Their effects are typically modest and work best alongside diet, exercise, sleep optimization, and medical care. Always individualize choices and monitor with objective health indicators.

5) Are omega-3s helpful for everyone with fatty liver?

Evidence supports omega-3s for lowering triglycerides and potentially reducing liver fat in some people. They are particularly relevant if triglycerides are elevated. Discuss dose and quality with your clinician and track changes in triglycerides and liver enzymes over time.

6) Is alcohol safe if I have fatty liver?

Even moderate alcohol can add stress to the liver, especially in NAFLD. Recommendations vary by individual risk. It’s best to discuss alcohol intake with your clinician, who can tailor guidance based on your liver health indicators and comorbidities.

7) What tests should I ask my doctor about?

Common starting points are ALT, AST, GGT, lipid profile, fasting glucose or A1C, and an abdominal ultrasound. Noninvasive fibrosis scores (e.g., FIB-4) help assess scarring risk. Depending on results, your clinician may suggest elastography or specialist referral.

8) How long does it take to see improvement?

Some people see changes in liver enzymes and triglycerides within 8–12 weeks of sustained lifestyle change. Significant reductions in liver fat on imaging may take several months. Fibrosis improvements, if possible, usually require long-term consistency.

9) Can thin people get fatty liver?

Yes. “Lean NAFLD” occurs in people without obesity and often involves genetics, visceral fat distribution, or dietary factors. The approach still centers on lifestyle, targeted evaluation, and individualized risk reduction.

10) Are statins safe if I have fatty liver?

Most guidelines consider statins safe in NAFLD and they reduce cardiovascular risk, which is a major concern in fatty liver. Mild enzyme elevations alone are not usually a reason to stop statins. Always coordinate decisions with your clinician.

11) Do coffee or tea help liver health?

Moderate coffee intake has been associated with lower risk of liver fibrosis in observational studies. Mechanisms may include antioxidant and anti-inflammatory effects. Choose unsweetened options to avoid excess sugar.

12) Should I try a liver “cleanse” or detox?

There is no robust evidence that short-term cleanses or detoxes improve fatty liver and some products can be harmful. A consistent, sustainable approach to nutrition, activity, sleep, and medical monitoring is more effective and safer in the long run.

Conclusion

Fatty liver is common—and often quiet in its early stages. Recognizing patterns like persistent fatigue, mild right-upper quadrant discomfort, weight challenges, elevated liver enzymes, and incidental imaging findings can prompt timely evaluation. Yet symptoms alone rarely reveal root causes. Objective liver health indicators—blood tests, imaging, and noninvasive fibrosis scores—are essential for clarity and appropriate follow-up.

Most meaningful improvements start with lifestyle: a nutrient-dense, lower-sugar dietary pattern; regular physical activity; steady sleep; and attention to metabolic health. Some people may benefit from carefully selected nutritional supplements—such as omega-3s, vitamin E in select circumstances, NAC, silymarin, curcumin, magnesium, and targeted micronutrients—to complement these foundations. Because individual biology and risks vary, work with your healthcare team to create a personalized plan and track progress over time. Thoughtful, stepwise changes can protect liver function and support long-term well-being.

Keywords

fatty liver, liver health indicators, hepatic steatosis symptoms, liver fat diagnosis, nonalcoholic fatty liver clues, early fatty liver signs, NAFLD, NASH, insulin resistance, triglycerides, omega-3 fatty acids, vitamin E, NAC, silymarin, curcumin, magnesium, vitamin D, choline, Mediterranean diet, transient elastography, FIB-4, metabolic syndrome