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Fatty Liver Disease

By: Gwen Y. Reyes-Amurao, M.D.Fatty Liver Disease

The liver is one of the most resilient organs in the body performing several vital functions. It plays a major role in human metabolism, including storage of sugar and energy, decomposition of red blood cells, protein synthesis, hormone production and detoxification. It also produces chemicals in the body that is necessary for digestion. It supports almost every organ in the body. One of its most important roles  is the removal of toxins from the body, whether it’s from medications, food, alcohol or any other substance that can be harmful to one’s health.  Because of this, the liver is greatly at risk for injury affecting its overall function and performance.

What is Fatty Liver?

Fatty liver, also known as steatosis, is a general term that describes the accumulation of fats in the liver. It results from a buildup of fatty tissue through time especially when a person’s diet exceeds the amount of fat the body can handle. Since it is a reversible condition, it often resolves on its own. But through repeated damage, scarring may result to permanent liver damage or cirrhosis.

Causes

Metabolic disorders, such as insulin resistance and elevated cholesterol levels are some of most common causes of fatty liver disease. Excessive alcohol intake has also been associated with a higher incidence of fatty liver in an individual. Studies conducted by the Philippine General Hospital, showed that this was more likely to occur in females who drank alcohol than males. Why? Because the women’s ability to metabolize toxic alcohol levels was found to be much lower than those of the males. According to the Journal of Gastroenterology and Hepatology, other common causes of fatty liver disease include prolonged intake of medications that are cleared through the liver (aspirin, macrolides, statins, etc.), advanced age, physical inactivity, high fat intake, overeating, recent and sudden weight gain, family history of obesity and/or diabetes and family history of fatty liver.

Signs, Symptoms and Diagnosis

Fatty liver often does not present with any symptoms. Some may report vague feelings of abdominal discomfort specifically in the right upper part of the abdomen. When the liver is inflamed or swollen due to fatty deposits, observable symptoms include poor appetite, weight loss, easy fatigability and sometimes a palpable liver on examination.

Prognosis of Fatty Liver Disease

According to the American Family Physician Journal, non-alcoholic fatty liver disease was not associated with an increased risk of mortality, cardiovascular disease, cancer or other liver diseases. Although hepatic steatosis rarely progressed to cirrhosis, some progressed to fibrosis, the thickening and hardening of the tissues that eventually lead to cirrhosis. Cirrhosis is a chronic disease of the liver characterized by degeneration of cells, inflammation, and thickening of tissue. Those with cirrhosis should be frequently monitored for disease progression and hepatocellular or liver carcinoma.

Diagnosis

Since liver enlargement is not always found in those with fatty liver disease, blood tests specifically for liver enzymes will determine the presence of this condition. But because these enzymes can be elevated even in the presence of other liver diseases, an ultrasound, CT scan or MRI can be done to confirm it. Liver biopsy is also sometimes advised to determine the specific cause of the fatty liver, especially in the absence of alcohol intake.

Treatment

Treatment for fatty liver disease will depend on its specific cause. If obesity and high cholesterol levels are the root cause, the doctor may advise cholesterol-lowering medications that have very little or no side effects on the liver. When associated with alcohol, it must immediately be removed. Diabetic patients with fatty liver are also given maintenance medications to control blood sugar levels and prevent further damage to the liver.

Overall, the physician may advice a change in lifestyle to prevent progression of liver disease. The 2012 practice guideline from the American Association for the Study of Liver Diseases (AASLD), the American College of Gastroenterology (ACG), and the American Gastroenterological Association (AGA) made the following recommendations regarding treatment of Non-alcoholic Fatty Liver Disease (NAFLD):

· Weight loss generally reduces hepatic steatosis, but up to 10% weight loss may be needed to improve swelling of the liver

· Patients with NAFLD should not consume heavy amounts of alcohol

  • Vitamin E 800 IU/day improves liver histology in non-diabetic adults with biopsy-proven non-alcoholoc steatohepatitis (NASH); it should therefore be considered as a first-line treatment for these patients.
  • Omega-3 fatty acids may be considered as first-line treatment for those with high cholesterol in patients with NAFLD

·  Abstinence from alcohol may reverse steatosis in patients with alcohol-related fatty liver. The steatosis usually resolves within 2 weeks of discontinuance of alcohol.

Monitoring Fatty Liver Disease

Individuals with fatty liver disease are at risk for liver disease progression. They must constantly be reminded to avoid alcohol and other substances that damage the liver. They should also be seen regularly by their personal physician for regular monitoring of cholesterol levels, progression of signs and symptoms or progression of liver disease based on imaging studies. 

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