Fatty Liver and Liver Health in London 2026. What Your Liver Tests Mean, How Fatty Liver Is Found and How It Reverses
Metabolic dysfunction-associated fatty liver disease, formerly called non-alcoholic fatty liver disease, affects an estimated 20% to 30% of UK adults and is now the commonest liver condition in the country, yet most people who have it are unaware because it causes no symptoms until it is advanced. It travels with the conditions that make up metabolic syndrome, and it matters for 2 reasons. A minority progress to inflammation, scarring and cirrhosis, and fatty liver is itself a marker of cardiovascular risk, the commonest cause of death in people who have it. The encouraging part is how reversible it is.
Key points
Liver enzymes such as ALT are frequently normal in fatty liver, even with significant scarring, so a normal liver function test does not exclude it.
What decides management is the degree of fibrosis, estimated first with the FIB-4 score from routine bloods, then with elastography where needed.
Losing around 5% of body weight reduces liver fat, 7% to 10% can resolve the inflammation, and 10% or more can partly reverse early scarring.
Fatty liver is not confined to people who are visibly overweight. Lean fatty liver occurs, particularly in people of South Asian family background.
Want your liver properly assessed? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
Who is at risk of fatty liver
Anyone carrying weight around the middle, since central fat tracks liver fat more closely than overall weight. People with type 2 diabetes or prediabetes, in whom fatty liver is very common and progression to fibrosis more likely. People with high triglycerides, low HDL cholesterol or high blood pressure. People with polycystic ovary syndrome or obstructive sleep apnoea.
It is not confined to people who are visibly overweight. Lean fatty liver occurs, particularly in people of South Asian family background, who develop metabolic disease at a lower body weight.
Alcohol is a separate and additive cause. Metabolic and alcohol-related liver damage frequently coexist, and the combination accelerates scarring more than either alone, which is why alcohol intake is asked about honestly in every assessment.
The people who most need assessment are those with diabetes or several metabolic risk factors, because they carry the highest chance of significant fibrosis and would benefit most from knowing.
Why a normal liver function test does not rule it out
This is the most important and least understood point. ALT and AST, the enzymes on a standard liver panel, rise when liver cells are inflamed, but they are normal in a large proportion of people with fatty liver, including some with significant scarring. A result reported as normal is therefore not reassurance.
Ultrasound detects fat in the liver reasonably well once it is moderate, and it assesses the liver's shape, texture and blood flow, the gallbladder and the spleen. It does not reliably measure scarring, which is the thing that predicts outcome.
Fibrosis is what matters, and it is estimated in steps. The FIB-4 score is calculated from age, ALT, AST and platelet count, all from routine blood results, and it separates people at low risk of advanced fibrosis from those needing further assessment. The Enhanced Liver Fibrosis blood test is a second step. Transient elastography, often known by the device name FibroScan, measures liver stiffness directly and is the next step where the scores are indeterminate or raised. NICE and British liver guidance recommend this stepwise approach so that the small number with significant scarring are identified without every person needing specialist imaging.
Not sure whether you need testing? Ask on WhatsApp or email team@thewellnesslondon.com.
How fatty liver reverses
Weight loss is the treatment with the strongest evidence, and the relationship with outcome is dose dependent. Losing around 5% of body weight reduces liver fat. Around 7% to 10% can resolve the inflammatory form, known as steatohepatitis. Losing 10% or more can partly reverse early fibrosis. Those figures come from paired liver biopsy studies and they are the reason fatty liver is described as reversible.
The route matters less than sustaining it. Reducing refined carbohydrate, sugary drinks and fructose, which the liver converts directly to fat, has particular relevance. A Mediterranean-pattern diet has good evidence independent of weight loss. Regular exercise, both aerobic and resistance, reduces liver fat even without weight loss, which matters for people struggling to lose weight.
Alcohol reduction is essential where intake is above recommended limits, and complete abstinence where there is significant fibrosis.
Treating the associated conditions protects the liver and the heart together, including diabetes, blood pressure and cholesterol. Some of the newer weight management and diabetes medicines reduce liver fat substantially and are considered where licensed and clinically appropriate after assessment, and a medicine specifically licensed for steatohepatitis with fibrosis has become available through specialist hepatology pathways.
Coffee drinking has been consistently associated with lower rates of liver fibrosis in observational studies, which is a pleasant finding though not a treatment on its own.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What liver assessment costs
Consultant hepatology and gastroenterology appointments in the Harley Street district run £250 to £500 for a first consultation, with scans and tests charged separately. Private liver ultrasound is billed per region, reaching around £415 at some central London hospitals before consultation and reporting. Transient elastography runs £200 to £500. The Enhanced Liver Fibrosis test runs £100 to £250. Comprehensive imaging programmes at the top of the market exceed £32,000.
At The Wellness the assessment, the coordination and the review are one fee. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Executive Body Scan, consultant-reported imaging including liver and abdominal assessment with full bloods and consolidated review, from £5,995.
Twelve-month metabolic programme with monthly reviews, interval liver and metabolic testing, dietetic input and a maintenance plan, from £2,995.
Complete Biomarker Assessment, over 100 markers including liver function with FIB-4 fibrosis scoring, lipids with apolipoprotein B and HbA1c with fasting insulin, with extended review, from £1,400.
Liver ultrasound with assessment, consultant radiologist reporting and review, from £995.
Comprehensive Blood Panel including liver function, fibrosis scoring, lipids and HbA1c, with consultation and interpretation, from £495.
In-person consultation from £220. Same-day video consultation from £150. Mini consultation from £59.
Transient elastography, Enhanced Liver Fibrosis testing and hepatology referral to a named consultant arranged with the appointment booked.
Appointments within the week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for liver health
Because fibrosis is assessed rather than inferred from liver enzymes. A normal ALT does not exclude fatty liver or significant scarring, so the FIB-4 score is calculated from routine bloods and escalated to elastography where it is raised, following the stepwise approach NICE and British liver guidance recommend.
Because the liver is assessed as part of the metabolic picture. Fatty liver travels with insulin resistance, diabetes, high triglycerides and high blood pressure, and cardiovascular disease is the commonest cause of death in people who have it, so apolipoprotein B, HbA1c and blood pressure are assessed alongside.
Because reversal is supported rather than simply advised. The 5%, 7% to 10% and 10% weight loss thresholds are explained, a structured programme is available with monthly review and interval testing, and treatment of the associated conditions is started where indicated.
And because we own no scanner, so liver imaging goes to the centre best equipped for it with consultant reporting, and our advice that you do not need a scan carries weight.
Related reading
Prediabetes and type 2 diabetes remission covers the metabolic conditions fatty liver travels with, medical weight management covers the weight loss that reverses it, biomarker screening covers the panel, and private ultrasound scans explains how liver imaging is arranged.
Book a liver health assessment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about fatty liver
How common is fatty liver?
Metabolic dysfunction-associated fatty liver disease affects an estimated 20% to 30% of UK adults and is the commonest liver condition in the country. It travels with central weight gain, insulin resistance, type 2 diabetes, high triglycerides and high blood pressure, and most people who have it are unaware.
Can I have fatty liver with normal liver function tests?
Yes. ALT and AST are normal in a large proportion of people with fatty liver, including some with significant scarring, so a normal result is not reassurance. Fibrosis is estimated with the FIB-4 score from routine bloods and, where needed, elastography.
Is fatty liver reversible?
Yes, and in a dose-dependent way. Losing around 5% of body weight reduces liver fat, around 7% to 10% can resolve the inflammatory form, and 10% or more can partly reverse early fibrosis. Exercise reduces liver fat even without weight loss.
What is a FibroScan?
Transient elastography, often known by the device name FibroScan, measures liver stiffness directly to estimate scarring. It is used as a second step where blood-based fibrosis scores such as FIB-4 are indeterminate or raised.
Does fatty liver affect the heart?
Yes. Cardiovascular disease is the commonest cause of death in people with fatty liver, because it shares the same metabolic drivers. That is why apolipoprotein B, HbA1c and blood pressure should be assessed alongside the liver.
How much does liver testing cost in London?
Consultant hepatology appointments run £250 to £500 before tests, elastography £200 to £500 and liver ultrasound up to around £415 per region at some hospitals. At The Wellness liver ultrasound with reporting and review is from £995 and a comprehensive panel with fibrosis scoring and consultation from £495.
This article is for information and does not replace personal medical advice. Any medicine is considered only where licensed and clinically appropriate following assessment. Yellowing of the skin or eyes, vomiting blood or black stools need urgent assessment, and in an emergency call 999. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
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