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What is
Fatty Liver ?
Fatty liver or
Nonalcoholic Fatty Liver Disease (NAFLD)
is a condition or more accurately, a spectrum of conditions
in which fat deposits in the liver cells. These conditions
range from something called "simple steatosis" which is a
mild form of the disorder to something called NASH
(nonalcoholic steatohepatits) which can progress to
cirrhosis and even liver cancer. A liver biopsy is the
only way to distinguish between simple Fatty Liver, or NASH.
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Types of NAFLD
- Simple Fatty Liver - 20-30% of Americans have this
- NASH - Cases where fatty liver has lead to
inflammation of the liver are called NASH. 2-3% of
Americans have this
- Liver cancer and Cirrhosis. Approximately 10-15% of
patients with NASH will go on to develop one liver cancer
or cirrhosis
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Causes
of Fatty Liver
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Weight gain/ Obesity |
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Diabetes |
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Medications |
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Poor diet |
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Heavy alcohol intake |
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Steroid use |
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NAFLD has been associated with a condition called
The Metabolic Syndrome which can be precursor to diabetes.
It is conceivable that the presence of fatty liver may
identify individuals who are at higher risk of
developing diabetes. Such individuals would be well
advised to keep their weight under control ( people
with a body mass
index greater than 40 are much more likely to develop
NAFLD) and exercise
regularly to diminish their chances of developing
diabetes. These measures will also decrease the amount
of fat deposited in the liver.
How do I know
if I have Fatty Liver
The subject of
fatty liver usually comes up when a patient has routine blood
work. Often times they have elevated
liver enzymes, but when
the doctor does additional testing he finds no evidence of
viral hepatitis, alcohol abuse, drug
toxicity, the accumulation of copper (Wilson’s Disease) or
iron (hemochromatosis)
or other diseases that can cause liver enzymes to go up. In
this situation a sonogram is often done and the presence of
fat in the liver will suggest the diagnosis of fatty liver. To
confirm the diagnosis and differentiate between fatty liver
and NASH, you may be referred to a liver specialist (usually
a gastroenterologist) who may then order a liver biopsy.
How do you treat fatty liver?
To treat fatty liver you have to treat the underlying cause.
Diabetic patients should keep tight control of their sugar,
obese patients should lose weight, alcohol consumption should
be limited to one drink a day. In general, fatty liver is not
harmful and therefore, "treatment" should be limited
to doing things that would normally be wise recommendations
even if you did not have fatty liver. Since some
patients with fatty liver may go on to develop NASH, it is
best to try and control those factors that are causing fatty liver.
A low fat diet is usually recommended, but simple
carbohydrates like sugars and white starches ( bread, pasta,
and rice) should also be limited. Sometimes medications
to lower cholesterol are also recommended.
What is NASH?
As mentioned above, NASH is similar to fatty liver except for
the fact that there is inflammation and damage to the liver cells. No one
really knows why one person gets fatty liver and another gets
NASH, but obese patients are more likely to develop NASH. The only way to tell the difference between the two is
with a biopsy. The real problem with NASH is that it may lead
to cirrhosis( permanent scarring of the liver) or liver cancer in
10-15% of
patients. Usually this progression from NASH to
cirrhosis takes several decades.
So what do I do
now?
Once you have been diagnosed with fatty liver the primary goal
is to identify the causes of the individual's NAFLD and
determine if they can be corrected. Risk factors should be
identified and addressed. If the individual is obese then a
strict diet to lose weight should be started. If they are
consuming large amounts of carbohydrates or alcohol then these
should be limited. Diabetic patients should have their HgbA1c
checked, and if their diabetes is not well controlled then
that should be corrected. Medications such as Methotrexate,
Steroids, Amiodarone, Tamoxifen, and Calcium Channel Blockers
can also contribute to NAFLD. If taking these meds the
individual should review them with his doctor. The take home
message is that most of the causes are within the individuals
power to control.
Most cases of NAFLD can be
reversed if the individual makes the appropriate life style
changes. After instituting these changes the individual should
have his liver function tests repeated approximately 6 months
later. If they are still elevated, your physician will most
likely refer you to a liver specialist for a liver biopsy to
determine the severity of the NAFLD. If there is evidence of
inflammation/ NASH then a more aggressive plan of treatment and
monitoring may be recommended.
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