Hi thanks for asking questions ..... Noted she has elevated ESR and fatty liver... ESR elevated because of inflamation , infection or malignancy..... Fatty liver not affect it..... But by hepatitis ESR can be elevated... Here detailed history and examination needed to search for cause if elevated ESR. High ESR suggestive some oraganic condition. USG , CBC , LFT , RFT like detail investigation work up done if cause not getting clear.... For fatty liver junk food and fatty food taken very much less .with more fruits.... Regular exercise done... If you give detail history about any other symptoms further comment can given... Take care.