FATTY LIVER
By Sanaz Majd, MD
If your doctor has diagnosed you with “fatty liver,” you are definitely not alone. In fact, studies estimate that up to 46% of the U.S. population may have fatty liver, and this continues to rise as our obesity epidemic worsens. It is by far the most common medical condition of the liver in both men and women.
What Is Fatty Liver?
You may have also heard the condition referred to as “Nonalcoholic Fatty Liver Disease” (NAFLD), but we use “fatty liver” for short.
Liver biopsies taken from patients diagnosed with fatty liver show fat droplets within the cells under the microscope; hence, the term “fatty liver.” But the condition does not necessarily correlate with body weight. Although patients who are overweight have a higher risk of fatty liver, not all patients with fatty liver may be overweight and not all overweight patients have fatty liver.
There is a spectrum of disease, with various stages of fatty liver ranging from a mild and potentially reversible process, to more advanced disease with inflammation and scarring of the liver. In order to further determine the severity of the damage caused by these fatty droplets in patients deemed higher risk, a liver biopsy may be performed.
Most patients do not require a liver biopsy, however. Most cases of fatty liver are reversible, but occasionally can inflame the liver, cause enlargement (termed “hepatomegaly”), and even cirrhosis. Therefore, it is a potentially serious medical condition, especially if left untreated.
Who Is At Risk?
Unfortunately, those with fatty liver may be unaware of it, as it often is silent and void of symptoms. But patients who are most at risk for fatty liver are those with the following medical conditions:
- Type II Diabetes
- Prediabetes
- Elevated cholesterol
- Hypertension
- Metabolic syndrome
- PCOS (Polycystic Ovarian Syndrome)
- Hypothyroidism
- Sleep apnea
- Obesity
- Medication side effects: amiodarone, tamoxifen, steroids, estrogen
Notice that many of the conditions on this list have a link to insulin-resistant states and/or conditions associated with weight gain.
How Is Fatty Liver Diagnosed?
Because those with fatty liver are often asymptomatic, it is typically discovered incidentally after running routine blood work, such as those done as part of a physical exam. AST (aspartate aminotransferase) and/or ALT (alanine aminotransferase) are the liver enzymes that are most involved.
Other conditions can cause elevated liver enzymes, as well, however:
- Alcohol consumption
- Hepatitis (such as types B & C, which can be chronic)
- Hemochromatosis (genetic disorder of excessive iron storage)
- Other less common hereditary conditions
So, as part of the detective work to discover the underlying cause for these elevations, your doctor may order further blood work and/or an ultrasound of the liver. Fatty liver is often confirmed on ultrasound. CT scans may also incidentally show fatty liver, but ultrasounds are better at visualizing the liver (and without the radiation exposure).
How Is Fatty Liver Treated?
If fatty liver is detected early on in the process before it progresses, its progression can be prevented. Here are some tips on how to help reverse fatty liver in its earlier stages:
Lose weight: This is arguably the most vital treatment goal in those with fatty liver, as weight loss has been shown to reverse the fatty infiltration of the liver. Set a goal of 1-2 pounds a week for an initial goal of 10% weight loss through both dietary modification and cardiovascular exercise for at least 30 minutes on most days of the week.
Optimize blood glucose control: For diabetics, this is key.
Lower cholesterol: This may include dietary modification and/or lipid lowering therapy.
Avoid alcohol.
Prevent further liver damage: Ensure Hepatitis B & C immunizations are up to date and/or there is immunity.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal doctor. Please always seek a licensed physician in your area regarding all health-related questions and issues.
Sanaz Majd, MD, is a board-certified Family Medicine physician and host of the Majd MD YouTube channel, reviewing the most popular medical topics: www.youtube.com/MajdMD. You can also follow her on Facebook or Instagram: @SMajdMD.
