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Fatty Liver

 
     

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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.

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
 

 Causes of Fatty Liver

bullet Weight gain/ Obesity
bullet Diabetes
bullet Medications
bullet Poor diet
bullet Heavy alcohol intake
bullet Steroid use
 

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.