As an actively practising hepatologist over the last decade, I have noticed a stark increase in the prevalence of fatty liver disease in recent times. To dissect this entity in simple terms, fatty liver refers to the accumulation of a significant amount of fat within the liver cells (called hepatocytes). This excessive fat in the liver can trigger inflammation or swelling, which is referred to as fatty liver-related hepatitis. Persistent inflammation in the liver is deleterious to liver health and can trigger scarring of the liver (also called fibrosis) in a certain subset of patients. Advanced fibrosis of the liver is termed cirrhosis of the liver, which can significantly impact its functioning. The most common causes of fatty liver are
- Non alcoholic fatty liver disease
- Alcoholic fatty liver disease
- Drug-induced fatty liver
Non-Alcoholic Fatty Liver Disease
Non alcoholic fatty liver disease is widely prevalent, and its incidence is rising steeply in India. The most important reason for non-alcoholic fatty liver disease is a poor lifestyle. People without any significant alcohol consumption (less than 20gm alcohol per day) are often puzzled at their ultrasound scan showing a diagnosis of fatty liver. The primary reason for the occurrence of fatty liver in such people is metabolic dysfunction, which often stems due to-
- Sedentary lifestyle
- Excessive visceral fat, which is depicted by their increased waist circumference (>90cm in men and >80cm in women)
- Prediabetes (fasting blood sugar > 100mg/dl but <126 mg/dl) or Diabetes mellitus (Fasting blood sugar≥126mg/dl)
- Hypertension (blood pressure >130/85 mmHg
- Poor cholesterol levels (Triglyceride cholesterol >150mg/dl and HDL cholesterol (good cholesterol) <40mg/dl in men and 50mg/dl in women
Patients having any of the above are at increased risk of developing non alcoholic fatty liver disease.
Alcohol related fatty liver disease
Alcohol related fatty liver disease is a condition which typically happens in people consuming a significant amount of alcohol (>20gm per day). {30ml of whiskey ≈100ml of wine ≈240ml of beer≈10gm of alcohol}. It is important to note that any amount of alcohol consumption is considered unsafe for the human body, as alcohol not only leads to fatty liver but also increases the risk of aerodigestive cancers.
Drug-induced fatty liver disease
Drug-induced fatty liver is an entity where in liver starts accumulating fat in response to certain medications. Steroids and tamoxifen (a drug given to prevent breast cancer recurrence) are examples of some of the drugs which can lead to this entity. It is thus very important to divulge every piece of information to your hepatologist so that he can accurately diagnose the condition and take appropriate steps to treat it.
Symptoms of fatty liver disease and an outline of its treatment
Most often, patients with fatty liver present with no symptoms. Occasionally, patients complain of vague, mild discomfort and pain in the upper right side of abdomen. Patients could complain of lethargy, tiredness, bloating sensation in their abdomen. Typical signs of liver involvement, like jaundice, itching of the skin, water accumulation in the abdomen and legs, often occur in the advanced stage of liver disease only (in the stage of cirrhosis). As the symptoms of early disease are so vague, it is recommended that people who have any of the above-mentioned risk factors or have a history of liver cirrhosis, liver cancer in the family be duly screened by a hepatologist.
Once diagnosed with fatty liver, you’re treating hepatologist will ascertain your risk factors of metabolic dysfunction and grade the severity of fatty liver (grade 1 –> 6per cent to 33per cent of liver cells contain fat, grade 2 -> 34per cent to 66per cent and grade 3 -> more than 66per cent liver cells contain fat). Your doctor would also assess the stage of liver fibrosis. The treatment of fatty liver disease is mainly focused on controlling the risk factors associated with the disease. Consuming a calorie-deficient diet and choosing an active lifestyle with 45 minutes of brisk activity daily is the most important lifestyle change a person can employ to prevent their fatty liver from progressing. It is important to note that only fat restriction in fatty liver disease management is a myth, and cutting calories from all sources is pivotal to reducing visceral fat. Adequate fibre and protein intake also helps patients with fatty liver. Brisk physical activity, including some amount of resistance training, aids in reducing liver fat. Your hepatologist would prescribe medicines only if needed to control the metabolic dysfunction parameters. Apt control of diabetes and hypertension is very important to curtail the progression of liver disease.
In summary, I would like to emphasise that the incidence of fatty liver disease is on the rise due to poor lifestyle choices. Fatty liver can lead to fibrosis, cirrhosis and liver cancer. People of younger age groups also seem to be affected in view of a sedentary lifestyle and a diet rich in calories, like junk food, fast food, and calorie-dense food. It is time we start talking more about fatty liver disease and get evaluated by a specialist in the presence of any of the above-discussed risk factors. Early diagnosis and appropriate changes in lifestyle can be the key to helping a patient suffering from fatty liver disease.
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