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Fatty liver disease -- causes, types, symptoms, diagnosis, treatment and prevention

Did you know you could get fatty liver without drinking alcohol? Understand how you can acquire it and what you can do about it.

Fatty liver diseaseOut of the long list covering more than 100 different forms of liver disease, fatty liver disease is one of the most common diseases that are spreading like an epidemic these days. Most of you might associate fatty liver disease with heavy intake of alcohol, which is true. But there are other ways you can acquire the disease. In this article Dr Jayshri Shah, Consultant Hepatologist, Gastroenterologist & Therapeutic Endoscopist at Ansh Liver Clinic explains all important aspects about the disease you should be aware about.

What is fatty liver disease?

Fatty liver simply means accumulation of fat in the liver. Normal, healthy liver has no fat. It is unclear where the fat comes from. It may be acquired from other parts of the body or the liver may be absorbing an increased amount of fat from the intestine. It could also be possible to explain fat accumulation, if the liver loses its ability to change fat into a form that can be eliminated.

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Types of fatty liver disease

Fatty liver disease can be divided into 2 types - alcohol related and non-alcohol related.

Alcoholic fatty liver disease: It is caused due to heavy alcohol drinking. Alcohol, in general, is bad for the liver because it diverts the liver from its major function of metabolising carbohydrates and providing glucose throughout the body. It destroys the liver cells resulting in fat deposits, causing alcoholic fatty liver disease. The fat in the liver can progressively cause inflammation and scarring of the liver, resulting in cirrhosis

Non-alcoholic fatty liver disease: There are 3 stages of non alcohol related fatty liver disease

  • Non-alcoholic fatty Liver (NAFL): It is not as serious as other forms since it doesn't lead to inflammation.
  • Non-alcoholic steato hepatitis (NASH): In this type, permanent liver damage can occur. The liver may enlarge and as the diseases progresses, the liver cells may get replaced by scar tissue causing cirrhosis. A person can also develop liver cancer and life-threatening conditions related to liver like liver failure.
  • Cirrhosis: Scarring of the liver tissue leads to cirrhosis.

Causes of fatty liver disease

Alcoholic fatty liver disease: It is caused by significant consumption of alcohol. Usually, consumption of greater than 21 units of alcohol/week in men and 14 units of alcohol/week in women, over a two year period is found to cause fatty liver. (One unit is equivalent to 10 ml of pure alcohol)

Non alcohol fatty liver disease: It is seen in patients who suffer with the following conditions in the absence of significant alcohol consumption:

  • Obesity
  • Type 2 diabetes
  • Insulin resistance
  • Hyperlipidemia
  • Hypothyroidism
  • Metabolic syndrome which requires the presence of 3 or more of the following features

    • Waist circumference greater than 102cm in men and 88 cm in women
    • Triglyceride level 150mg/dl or greater
    • High density lipoprotein (HDL ) cholesterol level less than 40mg/dl in men and less than 50mg/dl in women
    • Systolic blood pressure 130mm Hg or greater or diastolic pressure 85mm Hg or greater and
    • Fasting blood glucose level 110mg/dl or greater

Here are more causes and risk factors of liver disease

Symptoms of fatty liver disease

Fatty liver disease is a silent medical condition, which means there are usually no symptoms. In such cases, the disease is identified from routine health check up indicating fatty liver with ultrasound, CT scan or MRI of the abdomen. Patients should visit the doctor for further investigations even if they do not have any symptoms.

In case you experience the following symptoms, visit the doctor.

  • Fatigue
  • General feeling of being unwell
  • Right sided upper abdominal discomfort

As the disease progresses towards the advanced stages it can cause cirrhosis, where the following symptoms may be experienced:

  • Jaundice (yellowing of the skin)
  • Swelling of feet and abdomen
  • Vomiting blood
  • Bleeding from gums
  • Recurrent infections
  • Confusion

Diagnosis of fatty liver disease:

  1. Blood test: Some liver enzymes act as markers which can be detected using liver function tests. Some liver enzymes such as SGOT (aspartate transaminase -AST) and SGPT (alanine transaminase- ALT) might be elevated. Blood tests exclude other causes of fatty liver including blood sugar, lipid profile and thyroid function tests. They also check for viral hepatitis B and C which co exist in some patients with fatty liver disease without producing any symptoms.
  2. Ultrasound of the abdomen: Ultrasound uses sound waves to detect structural abnormalities of the liver. A fatty liver will appear 'echogenic,' more dense than usual, when visualised through ultrasound.
  3. Fibroscan: It is a non-invasive test similar to ultrasound that gives valuable information about the liver and helps quantify the amount of fat and degree of scarring (fibrosis ) in the liver. It takes few minutes to perform, is painless and result is available immediately.
  4. Liver biopsy: It is performed by taking a tissue sample from the liver with the help of a biopsy needle. The test is invasive and can cause pain, bleeding and usually requires patient to remain in hospital for 6-8 hours for observation. It is done in selected group of patients where liver disease appears to have advanced with inflammation and scarring. However, in most cases this procedure can be avoided if fibroscan is available

Read more diagnostic tests of liver disease

Treatment and prevention of fatty liver disease:

Treatment options include medication along with lifestyle and dietary changes.

Medication: Mostly for non-alcoholic fatty liver disease the treatment is given to control risk factors causing fatty liver. Medicines to control of diabetes, cholesterol , hypertension and hypothyroidism is required. In some cases, antioxidant medication such as Vitamin E can be prescribed.

Lifestyle measures:

  • Exercise: Obese individuals should lose of 3-5 % of body weight for improving their liver condition. In advanced stages, greater weight loss up to 10% may be required. Therefore, regular exercise for at least 30-60 minutes/day (3- 5 days of the week) is recommended.
  • Diet: Avoid high carbohydrates and fats in diet. Increase protein intake, fibre, in the form of fruits and vegetables.
  • Avoid alcohol: In patients who do not have fatty liver, the safe limits of alcohol consumption are as follows:

    • Men: Should not drink more than 21 units of alcohol/ week. Should not drink more than 4 units in one day
    • Women: Should not exceed 14 units of alcohol/week. Should not drink more than 3 units in one day.

Here are some expert tips to prevent the disease

  • Avoid alcohol
  • Exercise regularly
  • Eat a healthy diet
  • Get your liver function checked from a doctor who specialises in liver care, in case of any concerns.

Here are additional prevention tips for liver disease

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