Fatty Liver Disease

What are the different types of fatty liver disease?

The types of fatty liver disease are classified based on their cause or underlying factors.

Non-Alcoholic Fatty Liver Disease (NAFLD):
NAFLD happens when fat builds up in the liver even though you don’t drink much alcohol. It’s often linked to conditions like obesity, type 2 diabetes, high cholesterol, or insulin resistance. In the early stages, called simple fatty liver, it usually doesn’t cause problems. But in some people, it can progress to non-alcoholic steatohepatitis (NASH), where the liver becomes inflamed. This inflammation can lead to scarring (fibrosis), cirrhosis, or even liver failure if not managed. Unlike alcohol-related liver disease, NAFLD is mostly connected to your metabolism and lifestyle.
Alcohol-Related Fatty Liver Disease (AFLD):
AFLD is caused by drinking too much alcohol, which makes it harder for your liver to process fat. The more alcohol you consume, the more fat can build up in liver cells. If alcohol use continues, the condition can worsen, potentially leading to alcoholic hepatitis and eventually cirrhosis. AFLD can progress faster than NAFLD, especially if heavy drinking continues, increasing the risk of serious liver damage.

What causes Fatty Liver Disease?

Fatty liver occurs when fat accumulates in liver cells due to an imbalance between fat production and breakdown, caused by several contributing factors.

Liver Infections: Conditions like hepatitis can promote fat buildup, especially when combined with other risk factors.
Genetics: A family history of liver disease can make you more prone to developing fatty liver.
Lack Of Physical Activity: A sedentary lifestyle slows metabolism, making fat buildup more likely.
Rapid Weight Loss Or Malnutrition: Losing weight too quickly can release fat into the liver.
Excessive Alcohol Consumption: Drinking heavily disrupts fat metabolism and can damage the liver.
Certain Medications: Some drugs for cancer, heart disease, or mental health may affect liver function.
Obesity: Carrying extra body weight can increase fat storage in the liver.
Insulin Resistance And Type 2 Diabetes: Problems with blood sugar control can lead to fat building up in the liver.
High Cholesterol And Triglycerides: Having high levels of fats in your blood can contribute to liver fat.
Unhealthy Diet: Eating too many processed, sugary, or fatty foods can increase fat in the liver.

Diagnosis of Fatty Liver Disease

Fatty liver is often found during routine check-ups since early stages may have no symptoms. Diagnosis includes reviewing your medical history, a physical exam, blood tests, and imaging scans.

Liver Biopsy: Liver biopsy is the most precise way to assess liver damage but is only needed if other tests are unclear or severe disease is suspected. A thin needle collects a small liver sample for examination, done under local anesthesia with minimal discomfort.
Imaging Tests: Imaging tests help confirm fat in the liver and assess its severity. Ultrasound is the most common, noninvasive test, while CT scans and MRIs provide more detailed views and detect early scarring. FibroScan, a specialized ultrasound, measures liver stiffness and estimates fat content more accurately than standard ultrasound.
Blood Tests: Blood tests evaluate liver function and detect inflammation or damage. They include liver enzymes (ALT, AST, ALP, and GGT), lipid profile, blood sugar and HbA1c for diabetes, C-reactive protein for inflammation, and tests to rule out viral hepatitis.
Medical History & Physical Examination: During the medical history and physical exam, doctors review your diet, lifestyle, existing health conditions, family history, and medications that may affect the liver. They also check for liver enlargement and, in advanced cases, signs like jaundice or swelling in the abdomen and legs.

What are the fatty liver disease risk factors?

Several health conditions can increase the risk of developing fatty liver (metabolic dysfunction-associated steatotic liver disease), such as:

Obesity: Extra weight, especially around the waist, increases liver fat.
Type 2 Diabetes: Poor blood sugar control can lead to fat buildup in the liver.
High Cholesterol: Elevated cholesterol levels contribute to liver fat accumulation.
High Triglycerides: Excess fats in the blood increase the risk of fatty liver.
Insulin Resistance: The body’s reduced response to insulin promotes fat storage in the liver.
Metabolic Syndrome: A combination of conditions like high blood pressure, obesity, and insulin resistance raises the risk.
Polycystic Ovary Syndrome (PCOS): Hormonal imbalance in PCOS can increase liver fat.
Obstructive Sleep Apnea: Poor oxygen levels during sleep may worsen fat buildup in the liver.
Underactive Thyroid (hypothyroidism): Slower metabolism can lead to fat accumulation in the liver.
Underactive Pituitary Gland (hypopituitarism): Hormonal deficiencies can affect liver metabolism.
Growth Hormone Deficiency: Lack of growth hormone can contribute to fat storage in the liver.

What treatment options are available for fatty liver disease?

Common Treatments Include:

Choose A Healthy Diet: Eat plenty of fruits, vegetables, and whole grains. Limit foods like white bread, processed meats, sugary drinks, and juices. Keeping track of what you eat can help you stay on track.

Exercise And Be More Active: Aim for at least 150 minutes of exercise per week. If you’re new to exercise, start slowly and get approval from your healthcare provider. More activity can help with weight loss and liver health.

Manage Your Diabetes: Follow your doctor’s advice, take medications as prescribed, and monitor your blood sugar closely to protect your liver and overall health.

Lower Your Cholesterol And Blood Pressure: Healthy eating, regular exercise, and medications can help keep cholesterol, triglycerides, and blood pressure in check, reducing stress on your liver.

Lose Weight: If you are overweight, try to slowly reduce calories and increase activity. Even gradual weight loss can help improve liver health. If losing weight feels difficult, your healthcare team can guide you.

Protect Your Liver: Avoid alcohol and substances that can harm the liver. Take medications exactly as prescribed, and check with your doctor before using herbal supplements or over-the-counter drugs.

Medical Treatment: If lifestyle changes aren’t enough, medical treatments may be needed. Doctors may prescribe medications to manage diabetes, high cholesterol, or high blood pressure; recommend vitamin E for certain cases; or consider new drugs under study for liver inflammation. In rare, severe cases where fatty liver leads to cirrhosis and liver failure, a liver transplant may be necessary.