Fatty liver disease is an issue that is affecting more and more people in Germany – often without them realizing it at first.

What is a fatty liver?

A fatty liver occurs when too much fat is deposited in the liver cells. The liver is a real all-rounder: it cleanses the blood, helps with digestion, stores energy and breaks down harmful substances. Normally, it contains very little fat, but if the balance is upset, it can become fatty. This is often caused by too much alcohol – this is known as alcoholic fatty liver. More common, however, is non-alcoholic fatty liver disease (NAFLD), which is caused by obesity, an unhealthy diet, diabetes or too little exercise.

In the early stages, a fatty liver hardly causes any symptoms – perhaps a feeling of pressure in the right upper abdomen or tiredness. It becomes problematic when it becomes inflamed (then it is called steatohepatitis) or scarred (liver cirrhosis). This can permanently damage the liver and even lead to cancer. In Germany, around one in four people have a fatty liver, and the numbers are rising – one reason why doctors are taking the issue seriously.

Why are liver values important?

The liver is patient and often reports problems late. This is why blood tests, known as liver tests, are an important way of detecting whether something is wrong at an early stage. These values show how well the liver is working and whether it is damaged. In the case of a fatty liver in particular, this helps to monitor the progression and intervene in good time – for example by changing your diet or exercising before things get worse.

How are liver values measured in Germany?

In Germany, laboratory medicine takes care of the exact examination of liver values. Everything usually starts with the family doctor. If someone has risk factors such as obesity or feels weak, the doctor sends them for a blood test – either in the doctor’s surgery or in a special laboratory. A small amount of blood is taken from the vein, usually from the arm. You don’t always have to be fasting, but the doctor will tell you beforehand if this is necessary.

The blood is then examined in the laboratory for certain substances that reveal something about the liver. The most important liver values are

• ALT (alanine aminotransferase) and AST (aspartate aminotransferase): These are enzymes that are located in the liver cells. If the cells break down – for example due to fat deposits or inflammation – they are released into the blood. High values can indicate a fatty liver or damage.
• GGT (gamma-glutamyltransferase): This enzyme often rises with alcohol abuse or a fatty liver. It shows how heavily the liver is burdened.
• Bilirubin: A breakdown product from red blood cells that the liver normally excretes. If it is overloaded, the value rises and the skin can turn yellowish.
• Alkaline phosphatase (AP): A high value can indicate problems with the bile ducts, which are sometimes affected by a fatty liver.

The laboratories use modern devices that measure these substances automatically. The results are given in units such as U/l (units per liter) for enzymes or µmol/l for bilirubin. In Germany, there are guideline values: for example, ALT is normally below 50 U/l for men and below 35 U/l for women. However, every person is different and the doctor looks at the overall picture.

What happens to the results?

The laboratory values are returned to the doctor, who discusses them with the patient. If the values are slightly elevated, this can be normal for an early fatty liver – it is often enough to lose weight or drink less alcohol. Severe deviations indicate inflammation or worse, in which case ultrasound or other tests are often necessary. In Germany, health insurance companies usually cover such examinations, for example for routine checks or suspected liver disease.

The role of laboratory medicine

Without laboratory medicine, it would be difficult to detect a fatty liver at an early stage. The equipment in the laboratories is so precise that it can detect even the smallest changes in the blood – long before symptoms appear. In Germany, laboratories must adhere to strict quality rules to ensure that the results are reliable. The interaction between doctor and laboratory helps to keep an eye on liver health and act in good time.

Conclusion: keep an eye on the liver

A fatty liver is not a death sentence, but it is a warning sign. Laboratory medicine in Germany makes it easy and safe to check how your liver is doing. A small blood test shows whether everything is in order or whether it is time to change your lifestyle. Anyone who is at risk, such as being overweight or drinking alcohol, should talk to their doctor – because a healthy liver is worth its weight in gold, and early action can make a big difference.

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Gender note. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple references and gendered designations are avoided for the sake of better readability ected.