This is a larger liver with more pronounced steatosis (fatty change). Such fatty change is most often "nutritional" in etiology when diet is poor in protein and/or when fatty acid metabolism is deranged and/or when liver cell function is impaired. Non-alcoholic fatty liver (NAFL) is frequent due to metabolic syndrome, obesity, and diabetes mellitus (all of which are related).

Chronic alcohol abuse may lead to hepatic steatosis. The carbohydrate deficient transferrin (CDT) test measures isoforms of iron transport protein transferrin. Consumption of ethanol more than 50 to 80 g/day for 2-3 weeks may increase serum CDT. The CDT may be higher in chronic heavy drinkers than light social drinkers.

Steatosis is reversible over weeks to months. Reduce alcohol consumption. Adopt a diet and exercise program to lose weight (a 10% weight reduction helps to prevent progression of steatosis to steatohepatitis and to cirrhosis).