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Fatty liver Causes, Complications and Risk Factors

This post is also available in: हिन्दी (Hindi)

What is fatty liver?

Fatty liver is a condition where an excess amount of fat gets deposited in the liver. Normally, a small amount of fat is present in the liver. When more than 5% of liver cells develop fat deposition, it is said to be fatty.

As per se, fatty liver in simple form is not a disease, but a byproduct of other conditions that affect fat metabolism. The abnormal metabolism of fat leads to excess fat which gets accumulated in the liver cells. In moderate to a severe form, accumulation of fat can affect the liver cells causing inflammation which may progress to fibrosis causing permanent damage and in extreme cases liver failure.

The potential of fatty liver to turn into inflammation and then fibrosis causing liver failure is the reason why management of the fatty liver becomes important at the right time.

Progression of non-alcoholic fatty liver disease

Based on the causes and the condition of the liver cells, fatty liver can be categorized into:

Alcoholic fatty liver disease (AFLD), which is caused by drinking a significant amount of alcohol. When alcoholic fatty liver is also accompanied by inflammation of liver cells, it is called alcoholic hepatitis. It can further complicate alcoholic cirrhosis which can cause death.

Non- alcoholic liver disease (NAFLD), are cases of the fatty liver where there is no to little consumption of alcohol and where no other cause could be identified for fatty liver. It can be further divided into two types.

• Non alcoholic fatty liver (NAFL): where there is just fat deposition in liver cells.

• Non alcoholic steatohepatitis (NASH): when the fat deposition is associated with inflammation of liver cells with or without fibrosis.

A simple fatty deposition is reversible while fibrosis can’t be reversed or treated. It can only be prevented. The only definite treatment for established cases of cirrhosis or liver failure is liver transplant which is a complex surgery with a long recovery period.

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How common is fatty liver?

The incidence of NAFLD in the world is found to be 6% to 35%. In India, the prevalence of NAFLD is from 9% to 32%. The lower spectrum of prevalence is seen in the rural population and higher prevalence is seen in the urban population.

The estimated prevalence of NASH is lower, ranging from 3 to 5%. The prevalence of NASH cirrhosis in the general population is not known.

In the case of alcoholic liver disease, about 20% of heavy drinkers are estimated to develop fatty liver, and about 10 to 15% alcoholics develop complications of cirrhosis.

What are the causes of fatty liver?

It is considered that fat deposition in the liver occurs due to abnormal metabolism of fat which can occur due to a number of causes ranging from some underlying diseases to the consumption of alcohol or certain medicines. However, in many cases, no direct cause of fat deposition can be identified which is termed as NAFLD. Thus, the causes of the fatty liver could be classified as:

I. Fatty liver caused directly by some other condition:

• Alcohol: significant consumption of alcohol can lead to the fatty liver which is called, Alcoholic fatty liver disease (AFLD). Significant alcohol consumption has been defined as more than 21 drinks for men and more than 14 drinks for women on average per week. Know what is called a standard drink size.

• Starvation

• Parenteral nutrition: Nutrition given through blood vessels.

• Medicines such as corticosteroids, methotrexate, tamoxifen (medicine for breast cancer), amiodarone (medicine for arrhythmias), valproate (medicine for seizures), anti-retroviral medicines, certain cancer chemotherapy medicines especially for colon cancer.

• Infection: Hepatitis C (genotype 3)

• Diseases: such as Wilson’s disease, Reye’s syndrome, Lipodystrophy, HELLP syndrome, Acute fatty liver of pregnancy, Abetalipoproteinemia, Inborn errors of metabolism.

II. Fatty liver, where no direct cause can be identified.

These cases are categorized as Non- alcoholic liver disease (NAFLD). These cases are not associated with any direct secondary condition however, they are seen to be associated with several risk factors.

Some people with no identified metabolic problems may also develop the nonalcoholic fatty liver disease due to variation in their genes such as PNPLA3 variants 6

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What are the risk factors for NAFLD?

NAFLD is now considered a manifestation of the metabolic syndrome in the liver. Metabolic syndrome is a condition where multiple physiological and biochemical functions of the body are found to be deranged. When 3 or more of the following criteria laid down by the American Heart Association are found to be present the person is said to be having metabolic syndrome. These are as follows:

• Obesity: waist circumference of ≥90cm (35.4 inches) in men and ≥80cm (31.5 inches).

Diabetes mellitus: increased fasting blood glucose ≥100 mg/dL or taking medicines for high blood glucose.

• Dyslipidemia: increased triglycerides level in blood ≥150 mg/dL. Decreased good cholesterol (HDL) <40 mg/dL in men and<50 mg/dL in women.

• High blood pressure:  systolic BP ≥ 130 or Diastolic BP ≥ 85 mm Hg or taking medicines for high blood pressure.

Other risk factors:

• Age

• Insulin resistance

• High-calorie diet

• Diets high in sugar (fructose) and/or saturated fats

• Altered gut flora and

• Persistent inflammation

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How to identify fatty liver and its cause? How to diagnose fatty liver and identify the cause of fatty liver?

Fatty liver normally means the deposition of fat in your liver. Although, it is asymptomatic in nature, but can easily be identified with various lab tests, imaging tests and in some cases with the help of biopsy.

The lab tests involves blood tests such as LFT and lipid profile etc. In almost all cases the fatty liver is first identified by the ultrasound (USG Abdomen) test. This can be further confirmed with CT scan, elastography and MRI. Fatty liver can also be identified with the help of biopsy, where a needle is inserted in your liver to take liver cells from it.

The diagnosis of the fatty liver can be made with the help of all the above methods.

How to treat a fatty liver?

The problem of fatty liver is increasing day by day due to many lifestyle habits. Eating unhealthy food, sedentary lifestyle and alcohol consumption are some of the reasons behind fatty liver. Fatty liver may lead to the development of many serious diseases. You can reduce the fat in your liver by taking some important steps.

The treatment of fatty liver consists of:

• Weight reduction

• Medications

• Immunization

• Avoidance of alcohol consumption

• Coffee

• Bariatric surgery

Liver transplant

What are the complications of fatty liver? What fatty liver can lead to?

It is found that about 3 to 15% of people with obese NASH develop cirrhosis. It is also found that about 4 to 27% of people with NASH with cirrhosis develop into HCC.

The main complication of NAFLD/NASH is cirrhosis, where the liver becomes scarred with fibrosis. Cirrhosis develops due to the development of more and more areas of fibrosis which occurs in the process to stop inflammation in the liver cells.

In case of worsening of cirrhosis following problems are observed:

• Accumulation of fluid in the abdomen (ascites)

• Engorgement of veins in your food pipe (esophageal varices), which can rupture to cause bloody vomiting.

• Development of confusion, altered consciousness and slurred speech (hepatic encephalopathy)

• HCC (liver cancer)

• Liver failure: when the liver has significantly stopped functioning.

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