Fatty Liver to Cirrhosis Timeline: Prevalence, Treatment, and Outlook.

It usually takes years for fatty liver disease to progress to cirrhosis, but several factors affect the timeline.

Fatty liver disease is the buildup of fat in your liver, which can lead to inflammation. Long-term liver inflammation can lead to severe liver scarring called cirrhosis.

The two main types of fatty liver disease are alcohol-related fatty liver disease (AFLD), when the main cause is excessive alcohol consumption, and metabolic dysfunction-associated fatty liver disease (MAFLD)—previously known as non-alcohol-related fatty liver disease—when it isn’t linked to high alcohol consumption. MAFLD is highly related to low levels of physical activity and obesity.

It usually takes years to decades for fatty liver disease to progress to cirrhosis, but the rate of its development depends on factors like:

• whether you address the underlying cause
• the amount of alcohol you consume
• your lifestyle and dietary habits

Mild liver damage may be reversible if you seek treatment for the underlying cause, but experts don’t generally consider cirrhosis reversible.

Read on to learn more about how long it takes for fatty liver disease to progress to cirrhosis.

How often does fatty liver turn into cirrhosis?

The odds of fatty liver disease turning into cirrhosis largely depend on the underlying cause.

In a 2022 study, researchers followed 5,123 people with MAFLD for a median of 6.4 years. The risk of progression from MAFLD to cirrhosis was 3% after 15 years. Among 575 deaths, 6% were liver-related.

In a 2023 study, researchers found that the 10-year risk of MAFLD progressing to cirrhosis in more than 30,000 people was:

• 3.4% in adults under 40 years
• 3.7% in adults between 40 and 60 years
• 4.7% in adults over 60 years

The development of liver disease is linked to the quantity of alcohol you consume. It often develops in people who consume 30 to 50 grams (g) of alcohol per day for over 5 years, according to one paper. One standard drink contains roughly 14 g of alcohol.

The same paper says that fat buildup (steatosis) occurs in 90% of people who drink over 60 g per day. Cirrhosis develops in 30% of people with long-term consumption of more than 40 g per day.

How long does fatty liver take to turn into cirrhosis?

MAFLD tends to be a slowly progressing disease but accounts for about 30% of liver transplants in the United States. MAFLD can progress to a more severe condition called non-alcohol-related steatohepatitis (NASH), where you have fat and inflammation in your liver.

Scarring in your liver is called fibrosis. Fibrosis is divided into stages 0 to 4 depending on how severe it is. Stage 4 is also called cirrhosis.

Research suggests that the rate of progression of fibrosis varies widely. In one review, researchers estimated that it might take an average of 14 years for people with MAFLD and 7 years for people with NASH to progress one fibrotic stage.

About 10% to 20% of people with alcoholic hepatitis progress to cirrhosis annually. Alcoholic hepatitis is liver inflammation due to high alcohol consumption.

In a 2019 review, researchers examined the progression of alcohol-related liver disease in over 7,500 people. At the beginning of the study:

• 15% had a normal-looking liver
• 27% had excess fat in the liver (steatosis)
• 26% had excess fat and inflammation (steatohepatitis)
• 26% had cirrhosis

The annual rate of progression was:

• 1% for people with normal livers
• 3% for people with excess fat in the liver
• 10% for people with steatohepatitis

Some research suggests that AFLD may progress more rapidly to cirrhosis when combined with obesity or metabolic conditions like diabetes.

Can you reverse fatty liver disease?

Fatty liver disease may be reversible if you address the underlying cause before it advances to cirrhosis or advanced fibrosis.

Research suggests that fibrosis stops progressing or regresses in more than 20% of people with NASH. It’s not clear why it regresses in some people, but lifestyle habits likely play a role.

Can you reverse cirrhosis?

Experts don’t generally consider cirrhosis reversible, but if you address the underlying cause, you may be able to stop its progression.

The main treatment for AFLD is quitting drinking alcohol, ideally forever.

The main treatments for MAFLD are:

• losing weight, if needed
• increasing physical activity
• eating a balanced diet
• taking medications to lower:
  • cholesterol
  • triglycerides
  • blood pressure
• limiting medications that can damage your liver

Learn more about MAFLD treatment.

Outlook and life expectancy with fatty liver disease

The outlook for fatty liver disease depends on whether you address the underlying cause. If so, the outlook is often good. About 20% of people with MAFLD develop NASH, and roughly 10% to 15% of people with NASH progress to cirrhosis.

Outlook and life expectancy with cirrhosis

The outlook for cirrhosis is better in people with compensated cirrhosis versus decompensated cirrhosis. Compensated cirrhosis means that you haven’t yet developed symptoms of end stage liver disease, such as:

• jaundice
• confusion
• itchy skin
• swollen abdomen (ascites)

Decompensated cirrhosis is characterized by the presence of these symptoms.

The 10-year survival rate for compensated cirrhosis is about 47%, but it drops to 16% once a sign of decompensation occurs.

Takeaway

MAFLD often takes many years to progress to cirrhosis, but its rate of development can vary widely among people. Those with AFLD are at risk of developing cirrhosis within years if they continue drinking alcohol.

Liver damage can be reversible if you address the underlying cause before it progresses to cirrhosis. For MAFLD, the main treatment is losing weight, if you need to. For AFLD, it’s quitting alcohol.