Liver problems: How they arise, what damage they cause, and how many people are really affected

Why the liver suffers for a long time without you noticing – and why the problem is bigger than you think

The liver cannot feel pain. It can be under pressure for years without any clear warning signs. This is precisely why it is often completely underestimated.

Causes: How the liver comes under pressure

Several factors related to diet, lifestyle, and health can further strain the liver:

Diet and Lifestyle

• Obesity: A large proportion of excess body fat ends up in the liver – the most important trigger for fatty liver disease.
• High sugar intake, especially in drinks: Sugary drinks and highly processed foods directly stimulate fat production in the liver.
• Lack of exercise: An inactive daily routine intensifies other risk factors and makes it harder for the liver to shed fat.
• High alcohol intake: Regardless of body weight, alcohol is one of the best-known direct stressors on the liver.

Medical Factors

• When the body reacts poorly to insulin or has diabetes: This additionally promotes the storage of fat in liver cells and exacerbates existing damage.
• Certain medications: Some active ingredients, such as cortisone or certain HIV medications, further burden the liver.
• Chronic viral infections: Hepatitis viruses are among the most important causes of progressive liver damage worldwide.
• Several factors combined: Obesity, elevated blood lipids, high blood pressure, and impaired sugar metabolism affect the liver much more severely in combination than any factor alone.

Consequences: From silent onset to chronic disease

Fatty liver disease usually develops insidiously – from unnoticed beginnings to permanent damage:

• Usually no symptoms at first: In its early stages, fatty liver disease is usually asymptomatic and is often discovered incidentally during an ultrasound.
• If any, rather diffuse signs: Fatigue, exhaustion, or a slight feeling of pressure in the upper right abdomen – usually nothing more is felt.
• Inflammation can occur: If the causes persist, pure fatty infiltration can develop into inflammation – and with it, the risk of permanent damage increases significantly.
• Scarring and cirrhosis: If the inflammation persists, the liver tissue remodels and scars. In advanced stages, this is known as cirrhosis, where the liver is permanently impaired.
• Effects on the entire body: A strained liver does not only affect the local area but is closely linked to the entire metabolism, including blood sugar and blood lipids.
• A portion of cases worsen: If fatty liver disease remains untreated, a portion of affected individuals will develop more severe inflammation over time with a higher risk of secondary damage.

Prevalence: A widespread disease that is rarely discussed

Figures from Germany and worldwide show how prevalent liver diseases actually are:

• In the general population: Depending on the study, between 20 and 30 percent of adults in Germany have fatty liver disease – making it the most common chronic liver disease overall.
• The number increases with age: A study by the University of Greifswald found a proportion of 42.2 percent among 42- to 62-year-olds – significantly more than previously assumed.
• Rising trend: The number of affected individuals has been growing for years and is predicted to continue to increase until 2030 – parallel to obesity and type 2 diabetes in the population.
• A huge global issue: Globally, an estimated over 100 million people are affected, with a projected threefold increase in cases by the end of the decade.
• Many simply don't know: Because the disease so rarely causes noticeable symptoms, the actual number of affected individuals is likely to be even higher than officially assumed.

Why the liver holds out for so long before you notice anything

The liver can regenerate itself astonishingly well and compensates for stressors for a long time before anything is noticed. This very strength is also the problem: because the liver endures for so long, problems are often only noticed when quite a bit has already happened.