Fatty Liver Disease

What is Fatty Liver Disease?

Fatty liver disease describes a condition during which the liver stores excess fat where it shouldn’t. You may hear medical professionals call it hepatic steatosis.

Heavy drinking makes individuals more likely to get it. This is because high and chronic alcohol consumption leads to a buildup of fat inside the liver cells. This makes it more difficult for the liver to function properly.

Nevertheless, it is possible to suffer from fatty liver disease even if the individual doesn't consume a lot of alcohol on a regular basis. Read on the many faces of fatty liver.

Nonalcoholic Fatty Liver Disease (NAFLD)

There are two different types of nonalcoholic fatty liver disease:

• Simple fatty liver: This means there is fat in the liver, but it may not cause any inflammation or damage to the liver cells. It usually doesn’t get worse or cause any major further complications. Most people who suffer from NAFLD have a simple fatty liver.

• Nonalcoholic steatohepatitis (NASH): This condition is much more severe than a simple fatty liver. Individuals who suffer from NASH experience inflammation in their liver. The inflammation and liver cell damage that happen with NASH can cause serious problems, such as fibrosis and cirrhosis, which are types of liver scarring, and liver cancer. About 20% of individuals with NAFLD have NASH.

Alcohol-Related Fatty Liver Disease (ALD)

Individuals with alcoholic fatty liver disease are able to act preventatively. The symptoms usually decrease when the alcohol consumption is halted. On the other hand if the alcohol consumption continues, ALD can cause serious complications. These include:

• Enlarged liver. It doesn’t always cause symptoms, but individuals may experience pain or discomfort on the upper right side of the abdomen

• Alcoholic hepatitis. This is swelling in the liver that can cause fever, nausea, vomiting, belly pain, and jaundice (yellowish skin and eyes)

• Alcoholic cirrhosis. This is a buildup of scar tissue in the liver. It can cause the same symptoms as alcoholic hepatitis, plus:

  • Large amounts of fluid buildup in the abdomen (medical professionals call it ascites)

  • High blood pressure in the liver

  • Bleeding in the body

  • Confusion and changes in behaviour

  • Enlarged spleen

  • Liver failure, which can be fatal

The complications usually start with alcohol-related fatty liver disease. Then it evolves in alcoholic hepatitis and later on in alcoholic cirrhosis.

Symptoms of Fatty Liver Disease

There are often no symptoms indicating ALD and NAFLD. Some individuals may experience tiredness or pain in the upper right side of the abdomen where the liver is located.

If an individual suffers from NASH or gets cirrhosis, they may experience symptoms such as:

• Swollen abdomen

• Enlarged blood vessels 

• Larger-than-normal breasts in men

• Red palms

• Skin and eyes that appear yellowish (due to jaundice)

Causes

For ALD, the main cause is high alcohol consumption. In addition to that, the following parameters may also increase the risk:

• Obesity

• Malnourishment

• Chronic viral hepatitis, especially hepatitis C

• Genetic predisposition

• Age

The primary risk factors of NAFLD are:

• obesity

• type II diabetes

• metabolic syndrome including dyslipidemia and hypertension. 

However, diseases other than the metabolic syndrome can be associated with hepatic fat, and these might enter into the differential diagnosis of fatty liver disease of usual type. Some of these have specific clinical and pathologic features that make their distinction from NAFLD straightforward, but others are infrequent and easily overlooked. 

NASH is most common in patients who are overweight or obese. Other risk factors include:

• Diabetes

• High cholesterol

• High triglycerides

• Poor diet

• Metabolic syndrome

• Polycystic ovary syndrome

• Sleep apnea

• Underactive thyroid (hypothyroidism)

Diagnosis

As mentioned previously, fatty liver disease can happen without causing any symptoms. It’s usually diagnosed after routine blood testing to check the liver. The health care provider may suspect fatty liver disease with abnormal test results, especially if the patient is obese.

Imaging studies of the liver may show fat deposits. Some imaging tests, including ultrasound and MRI scans can help diagnose the disease and spot scar tissue in the liver. 

Ultrasound in the diagnosis of fatty liver (an idea of the technicalities)

Fatty liver is diagnosed based on the following ultrasound parameters: parenchymal brightness, liver-to-kidney contrast, deep beam attenuation, bright vessel walls, and gallbladder wall definition. Qualitative grades are conveniently labelled mild, moderate, or severe or grade 0 to 3 (with 0 being normal). Grade 1 (mild) (Figure 1) is represented by a slight diffuse increase in fine echoes in the hepatic parenchyma with normal visualisation of the diaphragm and intrahepatic vessel borders. Grade 2 (moderate) is represented by a moderate diffuse increase in fine echoes with slightly impaired visualisation of the intrahepatic vessels and diaphragm. Grade 3 (marked) is represented by a marked increase in fine echoes with poor or no visualisation of the intrahepatic vessel borders, diaphragm, and posterior portion of the right lobe of the liver.

Nevertheless, the gold standard that enables medical professionals to be certain that fatty liver disease is the only cause of liver damage is with a liver biopsy. 

A liver biopsy involves getting a tissue sample of your liver with a needle. The needle removes a small piece of liver tissue that can be looked at under a microscope.

Are you concerned about Fatty Liver Disease? 

At East Anglia Ultrasound Services we are offering the relevant blood testing and Upper Abdominal Ultrasound Scan. Book yours today or come in contact with our medical team to discuss your options. A medical report will be conducted on the same day of the appointment and will be sent to you along with the Ultrasound material to follow up with your GP.

Keeping your liver healthy

If you have been diagnosed with fatty liver disease, it is important to keep your liver as healthy as possible and avoid anything that can damage it. Here are some important things you should do.

Don’t drink too much alcohol. How much is too much remains controversial, but it’s probably best to avoid alcohol completely.

Make sure that none of your medications, herbs, and supplements are toxic to the liver.

Get vaccinated to protect against liver viruses hepatitis A and B.

Control other health conditions that might also affect your liver, and check with your doctor if you might have other underlying, treatable diseases contributing to your fatty liver.

Get regular screening tests for liver cancer if you already have cirrhosis.

What about drug medication?

Unfortunately, there are no FDA-approved medications for fatty liver disease. So far, the two best drug options affirmed by the American Association for the Study of Liver Diseases for biopsy-proven NASH are vitamin E (an antioxidant) and pioglitazone (used to treat diabetes). However, not everyone will benefit from these treatments, and there has been some concern about safety and side effects. If you have NASH, it’s best to speak to your doctor about whether these treatments are appropriate for you, as they are not for everyone. There are more drugs in the pipeline, some with promising initial study results.

The most effective fatty liver treatment:
Lifestyle Changes

The good news is that the most effective treatment so far for fatty liver disease does not involve medications, but rather lifestyle changes. The bad news is that these are typically hard to achieve and maintain for many people. Here’s what we know helps:

Lose weight. Weight loss of roughly 5% of your body weight might be enough to improve abnormal liver tests and decrease the fat in the liver. Losing between 7% and 10% of body weight seems to decrease the amount of inflammation and injury to liver cells, and it may even reverse some of the damage of fibrosis. Target a gradual weight loss of 1 to 2 pounds per week, as very rapid weight loss may worsen inflammation and fibrosis. You may want to explore the option of weight loss surgery with your doctor, if you aren’t making any headway with weight loss and your health is suffering.

It appears that aerobic exercise also leads to decreased fat in the liver, and with vigorous intensity, possibly also decreased inflammation independent of weight loss.

Eat well. Some studies suggest that the Mediterranean diet may also decrease the fat in the liver. This nutrition plan emphasises fruits, vegetables, whole grains, legumes, nuts, replacing butter with olive or canola oil, limiting red meat, and eating more fish and lean poultry.

Drink coffee, maybe? Some studies showed that patients with NAFLD who drank coffee (about two cups every day) had a decreased risk in fibrosis. However, take into consideration the downsides of regular caffeine intake.

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts of NAFLD & NASH,” “Cirrhosis,” “Symptoms & causes of NAFLD & NASH,” “Diagnosis of NAFLD & NASH,” “Treatment for NAFLD & NASH,”Clinical Trials.gov: “A Study of Pemafibrate in Patients With Nonalcoholic Fatty Liver Disease (NAFLD),” “Nonalcoholic Fatty Liver Disease (NAFLD) Pharmacological Treatment: Metformin Versus Atorvastatin,” “Treatment for Non-Alcoholic Fatty Liver With Different Doses of Vitamin E.” UpToDate: “Epidemiology, clinical features, and diagnosis of nonalcoholic fatty liver disease in adults.” University of Michigan Medicine: “Alcoholic Liver Disease.” Current Opinion in Gastroenterology: “Aging and liver disease.” NHS.uk