Updated: Dec 27, 2019
What is Fatty Liver?
Fatty Liver or Non Alcoholic Fatty Liver Disease (NAFLD) is build up of fat globules in the liver cells. It is the most common Liver Disease worldwide. Fatty liver by itself is a benign condition. But in a small percentage of individuals, Fatty Liver is associated with inflammation of liver cells. This is called Non-Alcoholic Steatohepatitis (NASH). NASH is a dangerous condition which can lead on to Liver failure and liver cancers.
What are the causes of Fatty Liver?
Although the causes of Fatty Liver & NASH are not known, it is frequently associated with the below conditions:
Obesity: About 70% of patients with Fatty Liver are obese. But Fatty Liver can also occur in people who are not obese also.
Diabetes: 75% of individuals with Fatty Liver and NASH have Type 2 (Adult) Diabetes. Resistance of cells to Insulin, which is an important hormone to control blood sugar levels is known to be the factor in it's development.
High levels of Bad Cholesterol: Majority of patients affected with NASH have high triglyceride levels, which is a bad form of cholesterol
Certain medications like steroids, Synthetic estrogens can cause fatty liver.
How do you differentiate between simple Fatty Liver and the dangerous NASH?
Fatty liver is usually found out on routine scans like Ultrasound, CT or MRI scan. It is not possible to differentiate between just Fatty Liver and NASH using scans. We do blood investigations called Liver function tests. In NASH, the liver enzymes called ALT and AST will be increased, in addition to fatty liver found on scans. To confirm NASH, a biopsy from the Liver is the test used. But biopsy is not necessary in every one.
A noninvasive test called Fibroscan that uses ultrasound to determine how "stiff" the liver is. This stiffness can then be used to estimate how much scarring there is in the liver and to determine if cirrhosis has developed. Where available, fibroscan is an alternative to liver biopsy for detecting liver scarring.
Are there any symptoms of Fatty Liver or NASH?
Most people with Fatty Liver or NASH have no symptoms. Rarely, NASH is found (after testing) in people with fatigue, a general feeling of being unwell, and a vague discomfort in their upper right abdomen, although it is not clear if these symptoms are related to NASH.
What is the progression of Liver disease in Fatty Liver and is it reversible?
The usual progression of liver disease due to Fatty liver is depicted above. The stages until NASH are reversible. But once liver undergoes scarring (Liver Cirrhosis), it is not reversible.
Does Fatty Liver without NASH need any treatment?
Fatty liver without NASH does not need any active treatment. If you are overweight or obese, losing weight can reduce the amount of fat in your liver. It will also prevent from progressing to NASH.
What is the treatment for NASH?
NASH is not treated directly. But the condition can get better when other medical conditions that often happen with NASH get treated. For example, losing weight, and controlling high blood sugar and cholesterol can help improve NASH.
With that in mind, your doctor can:
Help you create a weight loss plan, if you are overweight – If your doctor recommends that you lose weight, it's important to do so slowly. Do not lose more than 1.5 kilograms a week.
Treat your high blood sugar, if you have high blood sugar
Treat your high cholesterol, if you have high cholesterol
For severe NASH, doctors sometimes prescribe Vitamin E as there is some evidence to Vitamin E decreasing NASH. But take Vitamin E only after seeing a Liver doctor as it can have side effects also.