Fatty Liver – Who should worry?
Fatty Liver is a very common diagnosis. Most individuals are detected to have fatty liver on an Ultrasound scan of the abdomen done for some other medical reason. Some people have mild abnormalities on their blood tests related to the liver. When patients seek opinion from a doctor, they are told that fatty liver is an extremely common problem and is usually related to excess alcohol use, excess intake of fatty foods, lack of exercise and being overweight.
Patients are generally reassured that the most important step towards managing and treating the condition is cutting down on fats and exercising to lose weight. The concern here is that, fatty liver is often disregarded since the condition does not cause any physical problems. However, an individual with fatty liver must be well informed about the condition, causes of developing the condition, its risks and health consequences, treatment and prevention options etc. Above all one questions that arises in the minds of those with the condition is ‘who is the right Doctor to meet in this regard?’
In a nutshell, fatty liver is the accumulation of excess fat in the liver cells. The normal liver has less than 5% fat, while in patients with fatty liver disease; the fat content can go upto 30-70%. Once excess fat accumulates in the liver, it can undergo oxidation and begins damaging the liver cells. Over a period of time, lots of liver cells get damaged and the liver tries to repair the injury. Just like after any injury, healing occurs but a scar is formed. Similarly the liver also gets scarred over a period of time. In a small percentage of patients, this liver scarring is so extensive that a condition called liver cirrhosis develops that can lead to liver failure.
Alcohol intake is a common cause for development of fatty liver. However, the most commonly discussed condition is non-alcoholic fatty liver disease (also known as NAFLD) that happens in people who consume very minimal or no alcohol. This type of fatty liver disease is related to a defect in the body when excess fats, carbohydrates and other nutrients are unable to get metabolized and get deposited as fat globules in the liver cells. NAFLD is usually caused in overweight individuals and typically in people who have abdominal obesity, i.e. a fat belly. It also occurs in people who are diabetics since they have disordered carbohydrate metabolism. However, the condition is also caused in thin people. It is most common in young and middle aged individuals, although even overweight children who have improper dietary habits can develop this condition.
Most people with fatty liver disease experience no symptoms and hence they often ignore this problem. The most concerning issue is that in about one-third of individuals with fatty liver, the oxidation process of the fat leads to significant liver damage. And in about 10% of individuals, the degree of scarring in the liver is serious enough to cause liver failure in the future. It is also important to remember that the remaining two thirds of individuals have simple accumulation of fat in the liver and this fat does not lead to oxidation and liver damage. Therefore, the most important thing for a person detected to have fatty liver is to find out whether his liver is getting damaged by the fat or not.
Fatty liver is a part of an overall metabolic disorder in the body that also leads to development of diabetes, high blood pressure, high cholesterol and triglyceride levels. All of these in turn lead to heart disease. Hence once a person is diagnosed to have fatty liver, the risk of this person developing other medical problems also increases.
Amongst people who have fatty liver, those individuals who have diabetes, are overweight and have abnormal liver function tests are at the highest risk for progression of liver disease. There are special blood tests and scans of the liver that can accurately tell a person about the degree of liver damage.
One should not go by ultrasound reports showing mild fatty liver and believing that the problem is not significant. An ultrasound scan cannot predict the degree of underlying liver damage. Fibroscan is the scan that every patient with fatty liver should undergo in order to detect the actual degree of liver damage. It also helps in differentiating between individuals with severe form of fatty liver and those with simple fatty liver that will not progress.
The best way to prevent fatty liver is to maintain normal body weight and avoid eating fats and carbohydrates. Excess fructose containing drinks such as fruit juices also cause fatty liver. Proper control of diabetes and cholesterol is also important to prevent fatty liver. There are drugs such as vitamin E, pioglitazone and obeticholic acid that are used to treat fatty liver disease. Several new drugs are in advanced stages of medical trails and will soon be available for patients suffering from severe form of fatty liver disease. Patients who are overweight and have fatty liver should try to lose weight. If they are unable to lose weight naturally, surgical options like weight loss surgery or bariatric surgery may be the next course of action. Weight loss surgery has been conclusively shown to improve fatty liver disease.
The big question now is what to do if one is diagnosed or told by a doctor to have fatty liver disease. The assessment starts with looking for other diseases including diabetes, high blood pressure and high cholesterol and triglyceride levels that one may have. It is important to find out about the severity of fatty liver disease which is best understood with a Fibroscan of the Liver. It is also important to meet a specialist in Liver Diseases known as a Hepatologist to take proper opinion regarding the severity of fatty liver and what exactly needs to be done to prevent further worsening of liver disease.
Senior Consultant in Hepatology and Liver Transplantation
Aster Hospital, Mankhool