Fatty liver or non-alcoholic fatty liver (NAFL) is a common condition that results from the excess storage of fat in the liver. It affects up to 30% of the population and tends to be more common in patients with obesity, diabetes, high blood pressure and high cholesterol. Liver function is not always impaired for patients with NAFL. However, in some cases, the condition can lead to liver damage over many years. Simple fatty liver is different form the disease form of fatty liver, also known as non-alcoholic steatohepatitis (NASH). NASH involves the formation of scar tissue in the liver, whereas simple fatty liver is defined by the buildup of fat cells without liver scarring.
A healthy liver contains a small amount of fat. The patient develops fatty liver when the fat build-up exceeds 5-10% of the liver’s weight. Fortunately, fatty liver can often be prevented or reversed with lifestyle changes. Alcohol-induced fatty liver is another form of fatty liver caused by excess consumption of alcohol. It is important for the physician to establish the amount of alcohol consumed to be able to distinguish between alcohol-induced fatty liver and non-alcoholic fatty liver. Some patients may have both alcohol and non-alcoholic fatty liver disease.
Symptoms & Diagnosis
People with fatty liver disease often have no symptoms until the condition progresses to cirrhosis of the liver. Symptoms may include:
- Pain in the abdomen (belly) or a feeling of fullness in the upper right side of the abdomen
- Nausea, loss of appetite or weight loss
- Yellowish skin and whites of the eyes (jaundice)
- Swollen abdomen and legs (edema)
- Extreme tiredness or mental confusion
- Weakness.
Treatment
Often, your doctor is the first to notice fatty liver disease due to the lack of symptoms. Higher levels of liver enzymes revealed with a blood test for other conditions may serve as a warning sign. Elevated liver enzymes are an indication of a damaged liver.
In order to make a diagnosis, your doctor may order:
- An ultrasound to get a picture of the liver
- A FibroScan®, a specialized ultrasound often used instead of a liver biopsy to determine the amount of fat and scar tissue in the liver
- In some cases, a liver biopsy (tissue sample) to determine the extent to which the liver disease has progressed may be needed.
The mainstay of fatty liver treatment is weight loss in overweight and obese patients. We advise 10% weight loss over six months through diet and exercise. Certain diet types like the Mediterranean diet have demonstrated the potential to reduce fat and early liver scarring in clinical studies. For patients with the disease form of fatty liver (NASH), some medications can help in minimizing further scarring of the liver. If the patient develops advanced liver scarring affecting liver function, they will be evaluated for a possible liver transplant.
