Fatty Liver

Fatty liver

Fatty liver is a condition where fat builds up in liver. This built up of fat in liver can be caused by unhealthy alcohol consumption (known as Alcoholic Liver disease) and/or sedentary life style/unhealthy dietary habits (known as Non Alcoholic Fatty liver disease (NAFLD)). To be diagnosed with NAFLD a person must not have history of heavy alcohol consumption or other problem that can cause this condition such as Hepatitis C.
Majority of the patients who receive a diagnosis of fatty liver do so on an abdominal imaging done for other reasons (eg. to look for gall stones) or after an abnormal blood test results necessitating an abdominal imaging. A diagnosis of fatty liver can have a wide range of implications ranging from simple fat accumulation without any damage to liver cells (simply fatty liver) to excess fat leading to damage to your liver cells (known as steatohepatitis (NASH)) and eventually scarring in liver tissue (fibrosis), and when liver tissue is replaced by a lot of scarring and fibrosis, the structure and function of liver are disrupted (known as Cirrhosis).
Most patients with simple steatosis never develop liver inflammation (i.e. NASH) although some do. It is most frequently noted in persons who have diabetes, obesity and insulin resistance. The combination of these disorders is often called “metabolic syndrome”. Most people with simple fatty liver or NASH have no symptoms. However, some have a nagging persistent pain in the upper right part of the tummy (abdomen) caused due to an enlarged liver.
It has been noted that 70% of obese patients have fatty liver and about 20% of them have NASH. It is a common myth that fatty liver only happens in obese, as studies have substantiated that as many as 35% of lean individuals have fatty liver, though only about 3% of such individuals have NASH. It is estimated that 25 -30% of asian population have NAFLD and the numbers are rising at an alarming rate over the last few decades due to change in dietary and lifestyle habits of the population.
There is nothing alarming if you receive a diagnosis of fatty liver. It is estimated that on average only 2 in 100 people with simple fatty liver will progress to cirrhosis (i.e. advanced liver disease) in 15-20 years and about 12 in 100 people with NASH will progress to cirrhosis in about 8 years time. So most people with NAFLD are not at risk of serious liver disease though because of epidemic in obesity, NAFLD has increasingly becoming one of the most common cause of end stage liver disease.
Most patients noted to have fatty liver will have simple fatty liver but an evaluation by a physician/hepatologist/gastroenterologist is warranted for all. They will need a blood test (CBC, LFT, screening for diabetes and tests to rule out other cause of liver disease (eg Hepatitis-C). The patients suspected of having NASH/Fibrosis on these initial tests may need to undergo tests like Fibroscan which is a non invasive test that can estimate the amount of scarring in liver. Rarely the condition may necessitate a liver biopsy which may be needed to rule out some other causes of liver disease that cannot be ruled out with simple blood tests and will also detect degree of inflammation/scarring.
As highlighted that majority of patients with fatty liver will not develop advanced liver disease. It is of utmost importance to remember that cardiovascular diseases are the most common cause of death in patients with fatty liver and lifestyle changes and weight reductions forms the main pillar of management of NAFLD which not only prevents progression of liver disease but also reduces risk of development of cardiovascular diseases