Fatty Liver Disease: A Silent Killer

A. What is fatty liver disease and what are risk factors?

Fatty liver is an accumulation of fat in the liver which can cause damage to the liver cells and may progress gradually to liver failure. Fatty liver disease or non-alcoholic fatty liver disease (NAFLD) is a spectrum of a wide range of liver diseases. Overweight or obese people, diabetic patients have more risk of having a fatty liver.

B. How fatty liver disease occurs and how to know if you have this?

• NAFLD is a result of abnormal metabolism and excess calories and fat absorbed from food, transported to the liver and ultimately stored in the liver as fat.
• There are no symptoms for NAFLD, so-called a silent disease. It is usually identified incidentally on ultrasonography or fibroscan.

C. What are the grades and consequences of fatty liver disease?

• Fatty liver is graded as grade I, II or III depending on subjective assessment of fat accumulation in the liver. If you have fat but no inflammation or tissue damage, the diagnosis is NAFLD.
• If fat leads to inflammation and liver damage, the diagnosis is non-alcoholic steatohepatitis (NASH).
• Further, it can progress to fibrosis in the liver called fibrosis and irreversible liver damage called cirrhosis which can lead to Liver Cancer .

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D. What to do if you have a fatty liver?

If someone on routine screening or incidentally detected to have fatty liver, he should not panic as it is very slowly progressive and usually preventable & treatable disease. Ultrasonography and fibroscan of the liver along with few blood tests are done for detailed evaluation by a liver specialist. Self and inappropriate medication can further damage the liver.

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E. Is fatty liver life-threatening and what are the implications of this disease?

Fortunately, NAFLD can be detected easily and can be treated but progression to cirrhosis and liver cancers can be life-threatening. NAFLD is an important risk factor for heart-related disease ; many patients with it may dye from heart failure before they have liver failure.

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F. Can fatty liver be reversed?

Yes, it can be reversed if detected and treated at an early stage. If you have NASH, no medication is available to reverse the fat deposition in your liver. A healthy diet, increasing physical activity and medications can improve fatty liver and decrease the progression of advanced Liver Disease .

G. How to prevent and treat fatty liver disease?

1. Weight optimization in a controlled and safe manner
2. Diet modification: Reduce calories intake by 15-20%, reduce carbohydrates like sugars & starch, and avoid fats, soft drinks, fast foods and heavy meals
3. Eat a healthy balanced diet with more fruits and vegetables
4. Avoid alcohol
5. Check diabetes and get proper treatment
6. Increase physical activity, walking, exercise as advised by a doctor
7. Regular check-ups by a liver specialist
8. Specific medications to improve fatty liver and liver damage

Dr. Mahesh Gupta, Consultant – Gastroenterology, Dharamshila Narayana Superspeciality Hospital, Delhi