Non-alcoholic Fatty Liver Disease

What is fatty liver disease?
Fatty liver disease is the accumulation of extra fat in liver. Excess alcohol intake is a common cause of fatty liver. However, fatty liver also occurs in patients who do not drink or drink very little alcohol. This form of fatty liver disease is known as Non-alcoholic fatty liver disease (NAFLD).

Who is likely to have Fatty Liver?
Fatty liver (non-alcoholic) usually develops in people who are overweight, have diabetes, high cholesterol or high triglycerides. Poor eating habits with a diet rich in fats also may lead to fatty liver. Some people develop fatty liver even if they do not have any risk factors. Fatty liver may affect up to 10 percent of people in India.

What are the risks linked to Fatty Liver?
Fatty liver may cause liver inflammation or swelling. This may progress to cirrhosis (scarring of the liver) over several years and may even lead to liver cancer or liver failure. Most people with fatty liver and inflammation are between the ages of 40 and 60 years. It may not have any symptoms and people may feel absolutely healthy even though the liver may be significantly damaged. Since people are getting overweight, diabetes is on the rise and oily food is being consumed more commonly, fatty liver disease is going to become a common cause of cirrhosis and liver failure in India in the coming years.

What are the stages of fatty liver?
Fatty liver has the following stages:
Simple fatty liver
Fatty liver with inflammation (known as non alcoholic steatohepatitis or NASH)
Fatty liver with liver hardening and liver scarring (known as liver cirrhosis)
Most individuals with simple fatty liver do not progress to severe liver damage. However, about 10 percent individuals, especially those with several risk factors will progress to liver inflammation and cirrhosis. Once liver cirrhosis develops there is a high risk of liver failure, liver cancer and death.

What are symptoms of Fatty Liver?
Fatty Liver often has no symptoms. When symptoms occur, they may include fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, yellowing of the skin and eyes (jaundice), itching, swelling of the legs (edema) and abdomen (ascites), and mental confusion. Most of these symptoms occur when fatty liver has already lead to cirrhosis.

How is Fatty Liver diagnosed?
It is important to diagnose fatty liver early when there are no symptoms. A blood test (liver function test) usually shows elevation of liver enzymes. An ultrasound scan shows fatty liver. Several other blood tests and occasionally a liver biopsy may be required to make sure that there are no other reasons for these abnormal liver tests.

What are the associations of Fatty Liver Disease?
People with fatty liver disease are at higher risk of developing diabetes, high blood pressure, high cholesterol and triglyceride levels. They are also at higher risk of developing heart disease. It is important for these individuals to visit their doctor regularly so that appropriate tests can be done for early detection and treatment for these associated problems.

How should I do if I have Fatty Liver ?
Lose weight if you are overweight.
Exercise at least 30 minutes per day.
Reduce fat consumption in diet.
Avoid a carbohydrate rich diet (potatoes, white bread, white rice).
Diet rich in antioxidants (fruits, nuts, pulses and grains) is beneficial.
Avoid excess fruits juices and carbonated drinks rich in fructose.
Antioxidants such as Silymarin, vitamins C and E may have some benefit. Talk to your doctor before using these.
Perform annual health checkups for liver enzymes, blood sugar and cholesterol levels every year.
If you have diabetes and hypertension, treat it effectively.
Even if you a light alcohol drinker, it is ideal to stop alcohol consumption completely.
Consult a Liver Doctor (Hepatologist) to determine whether you have simple fatty liver or fatty liver with inflammation or cirrhosis

Is there a specific medicine for Fatty Liver?
Unfortunately there is no specific medicine that can reduce the amount of fat in the liver. Although some doctors prescribe vitamins and other liver protective medicines, in scientific studies no particular drug has been found to be effective. Occasionally if your doctor suspects that there may be too much inflammation in your liver, he may advise you to undergo a liver biopsy and then prescribe certain medicines that have been used in clinical trials and found to have beneficial effects.

I was diagnosed to have Fatty Liver and reassured. How often should I see a liver doctor?
You must see a liver doctor at least once a year and perform blood tests. During these visits you should also make sure that you have been checked for diabetes, high blood pressure and high cholesterol. You must also ask your doctor whether you need to check your heart. You must ask your doctor if you may be having a progressive form of fatty liver known as Non-alcoholic steatohepatitis (NASH).