Understanding Fatty Liver: Causes, Symptoms and Treatment.

The liver is an important organ in the human body that plays a role in metabolism, such as detoxification, glycogen storage, protein synthesis, and bile production. Fatty liver, as the name suggests, refers to a condition where there is an excessive accumulation of fat in the liver. Normally, the liver contains a small amount of fat. When more than 5% of liver cells have fat accumulation, it is medically defined as fatty liver. The severity of fatty liver is classified based on the percentage of fat content. Mild fatty liver is classified as having a fat content between 10% and 33%, moderate fatty liver between 33% and 66%, and severe fatty liver is when the fat content exceeds 66%, which can lead to complications.

Although fatty liver may not exhibit noticeable symptoms and does not immediately result in liver dysfunction, studies have shown that it increases the risk of developing complications such as steatohepatitis, liver fibrosis, and liver cirrhosis, leading to irreversible deterioration of liver function. Fatty liver is also closely linked to metabolic syndrome. In other words, individuals with fatty liver have a significantly higher likelihood of developing metabolic syndrome (diabetes, hypertension, and high cholesterol), which in turn increases the risk of other serious conditions, including coronary heart disease, stroke, and chronic kidney disease, among others.

Fatty liver can be classified into two types - alcoholic fatty liver and non-alcoholic fatty liver. The former is caused by long-term alcohol abuse, while the latter is related to metabolic dysfunction and is not associated with alcohol consumption. Non-alcoholic fatty liver was previously known as non-alcoholic fatty liver disease (NAFLD), which was defined as the presence of fat accumulation in more than 5% of liver cells in the absence of excessive alcohol consumption or other known liver-damaging factors. This exclusive diagnostic approach has been criticized for not clearly indicating the relationship between this condition and metabolic dysfunction. In 2020, a group of international experts proposed renaming non-alcoholic fatty liver disease to metabolic-associated fatty liver disease (MAFLD) and classifying it as a distinct disease entity with a more proactive set of diagnostic criteria. This aims to improve the diagnosis, treatment, and management of this condition, providing patients with more personalized care.

Fatty liver can have the following common causes:

1. Central obesity: Consuming an excessive amount of high-sugar and high-fat foods, coupled with a lack of exercise, leads to weight gain and the accumulation of a significant amount of fat in the body.
2. Type 2 diabetes: Individuals with diabetes often experience insulin resistance and metabolic syndrome, which disrupts the normal metabolism of fat in the body and results in the accumulation of fat in the liver.
3. Excessive alcohol consumption
4. Other causes include high levels of blood lipids, hepatitis C, medications such as steroids, antiretroviral drugs used in HIV treatment, and intravenous nutrition, among others.

Don’t assume that fatty liver is exclusive to individuals with normal body weight. According to Western standards, individuals with a BMI below 25 are considered to have a normal body weight. However, recent research has shown that approximately one in every five individuals with a normal body weight may still develop fatty liver. The medical community now recognizes that these cases may be associated with metabolic syndrome or genetic factors. Poor dietary choices and unhealthy lifestyle habits can also increase the risk of fatty liver. Therefore, even individuals who appear thin should not neglect regular check-ups to assess their liver health.

Patients with fatty liver generally do not exhibit obvious symptoms. Often, the condition is discovered when liver enzymes are found to be elevated during routine blood tests, followed by a liver ultrasound scan conducted by a doctor. The following are common methods used for diagnosing fatty liver:

Liver ultrasound examination

This non-invasive test allows doctors to visualize the presence of fatty liver through imaging. However, it can only diagnose mild to severe cases of fatty liver and may not detect very mild instances or determine the presence of liver fibrosis.

FibroScan

FibroScan is a newer, non-invasive test that uses sound waves to assess liver fibrosis. By transmitting ultrasound waves into the liver, it can accurately diagnose the extent of fibrosis. The latest generation of FibroScan can also measure liver fat content (CAP). The test takes only five minutes and provides higher accuracy compared to ultrasound.

Read more: Who should get a Fibroscan?

Liver biopsy

Liver biopsy involves obtaining a small sample of liver tissue for examination. It can accurately diagnose fatty liver and determine the presence of liver inflammation, fibrosis, and cirrhosis. However, liver biopsy is an invasive procedure and carries a slight risk (approximately 0.3%) of liver bleeding, so it is less commonly used in routine diagnosis.

Currently, there are no specific medications available on the market for the treatment of fatty liver. However, in certain cases, doctors may prescribe other medications to help patients maintain and promote liver health, as well as improve conditions such as high cholesterol, diabetes, and obesity, which can contribute to and worsen fatty liver. If you are diagnosed with fatty liver, seeking medical advice and making lifestyle changes are crucial.

For alcohol-related fatty liver, quitting alcohol is essential. For non-alcoholic fatty liver, it is important to understand the underlying causes and address them accordingly. If fatty liver is caused by obesity, weight loss becomes a key focus. If it is associated with diabetes, controlling blood sugar levels is important.

The most effective method to improve fatty liver is through weight reduction. A target of reducing body weight by 10% is often recommended. It is also advisable for fatty liver patients to choose a diet rich in vegetables, low in sugar and fat, and to minimize the consumption of processed foods. Regular exercise and physical activity are beneficial as well.

Early-stage fatty liver can be reversed, and maintaining a healthy lifestyle is crucial for long-term liver health. Regular check-ups with healthcare professionals are recommended to monitor the progress of the condition and ensure appropriate management.

In addition, we also provide weight management services in Virtus Medical. This programme is offered by a multidisciplinary team consisting of specialist doctors, registered dietitians, and physical therapists, which designs personalized weight management plans based on each patient’s individual condition. They use medical methods to monitor the progress of weight loss and provide continuous support through dedicated health consultants.

Read more: Weight Management Programme

Virtus Medical Endocrinology Diabetes and Metabolism Sepcialists

Virtus Medical Gastroenterology and Hepatology Sepcialists