Fatty Liver

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 steatosis and NASH.
Fatty liver 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 (see calculator in right panel) greater than 40 are much more likely to develop fatty liver) and exercise regularly to diminish their chances of developing diabetes. These measures will also decrease the amount of fat deposited in the liver.

Causes of Fatty Liver

  • Diabetes
  • Medications
  • Poor diet - high in carbohydrates
  • Heavy alcohol intake
  • Steroid use
  • Weight gain/Obesity

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, 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. In most cases no further testing will be needed but on occasion you may be referred to a liver specialist (usually a gastroenterologist) who may then arrange a liver biopsy to get further information on the extent of the condition and to determine if there is any scarring of the liver.

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 simple steatosis except for the fact that there is inflammation and damage to the liver cells. No one really knows why one person gets simple steatosis and another develops 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 main concern 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 someone has been diagnosed with fatty liver the primary goal is to identify the causes 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 fatty liver. If a patient is taking any of these medications 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 fatty liver 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, a referral to a liver specialist for a liver biopsy may be recommended to determine the severity of the fatty liver. If there is evidence of inflammation (NASH) then a more aggressive plan of treatment and monitoring may be recommended.

Types of Fatty Liver

  • Simple Steatosis - 20-30% of Americans have this. With simple steatosis there are fat deposits in the liver but no evidence of inflammation yet.
  • 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 liver cancer or cirrhosis.

BMI Calculator

How to improve your diet.

The same advice we give diabetics will also reduce the risks from fatty liver. This booklet written with diabetics in mind will provide advice and information on diet that is just as appropriate for patients with fatty liver. Click on the image below to download the booklet.

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Additional Considerations

Having fatty liver means that any additional insults to the liver can result in more harm than it would to a healthy liver. For this reason some experts recommend vaccinating all patient for Hepatitis B and A if they have fatty liver. Patients should discuss this option with their physician.