Since I do not know his medical history, there is no way I can tell you what is causing his fatty liver. At 32, I am suspecting heavy alcohol consumption to be a factor or obesity. The only way to reduce his bilirubin levels is to fix the fatty liver problem. This is either by loosing weight and/or abstaining from alcohol with the supplementation of thiamin.
The longterm risks of fatty liver include cirrhosis and liver failure.
One of the most important things to check is if he was exposed to hepatitis B or C when he was 20. This would ultimately determine if hepatitis B or C also plays a factor in his liver degeneration.
John Thai, MD