Resources for Patients: FAQs on Fatty Liver

What is fatty liver?
Fatty liver is the accumulation of excess fat in the liver.  It is also known as “hepatic steatosis” and is one of the most common liver diseases worldwide. Millions are affected who may or may not even know about it.  Excess fat in the liver is associated with a certain lifestyle – a lifestyle of too much “good food and drinks”.  There are two types of fatty liver disease – (1) Non-alcoholic fatty liver disease referred to as NAFLD and (2) Alcoholic fatty liver disease (AFLD).  Fatty liver is not a disease attributed solely to alcohol drinkers.  In the majority of cases, it is found among those who do not drink alcohol particularly those who are overweight, have diabetes and with high cholesterol levels.

How serious is this disease? What are the health risks associated with having a fatty liver?
Many people, patients and doctors alike have long been complacent when a diagnosis of fat in the liver is discovered.  Many think that having fat in the liver is an innocuous finding not associated with any serious health risks. It has been shown that people with fatty liver have a shorter life span compared to those without fatty liver.  The most common cause of death being cardiovascular disease, usually from heart attacks and strokes. This is the reason why people with fatty liver need to be screened for metabolic risk factors such as diabetes, heart disease, elevated cholesterol and high blood pressure.
In the same way that diabetes and high cholesterol lead to serious heart disease, fatty liver can also lead to serious liver damage.  When fat is accompanied by inflammation with subsequent damage of liver cells in a condition called non-alcoholic steatohepatitis (NASH), this can progress to significant liver damage in the form of liver cirrhosis, liver failure and eventually liver cancer.  Fortunately, not everyone with fatty liver disease develop these complications in the liver. Only those with uncontrolled diabetes, cholesterol and obesity are at highest risk in developing these complications.

What causes fatty liver? Who are at risk for fatty liver?
NAFLD is the expression of diabetes, high cholesterol and obesity in the liver.  It is the hepatic manifestation of the metabolic syndrome. Being part of a syndrome, the typical patient with NAFLD is also diabetic, hypertensive, overweight and has high cholesterol.  In the absence of the full-blown syndrome, the finding of fatty liver alone can be considered as an “early warning” suggesting the risk of developing these associated conditions in the future if not reversed early.

Alcoholic fatty liver disease on the other hand is a consequence of regular and habitual drinking of alcoholic beverages.  Consuming alcohol in excess leads to fat accumulation in the liver similar to what happens in NAFLD. This condition can be prevented by limiting alcohol consumption to levels that are not harmful to the liver. Binge drinking or drinking huge amounts of alcohol only on special occasions is just as bad as having a few drinks too many on a regular or daily basis.

Can fatty liver be treated? How?
The risk of developing diabetes, fatty liver and its complications is a product of bad genes and an environment characterized by a sedentary and inactive lifestyle. Some are genetically predisposed to have it and should therefore exert extra effort to prevent it.  A healthy and active lifestyle is the first step to reduce your chances of developing these conditions. If discovered early, fatty liver can be reversible.  Weight loss through a healthy diet and exercise coupled with good control of sugar and cholesterol levels and avoidance of too much alcohol are the most effective strategies known to prevent progression of fatty liver.

Does obesity cause or exacerbate fatty liver?
Being overweight and obese is a “red flag” that should signal the presence of an underlying fatty liver. It should also trigger a work-up for diabetes, high cholesterol and hypertension – these being commonly associated disease conditions with obesity.
Attention to it is commonly a result of finding “hepatic steatosis” or “fatty liver” on ultrasound or abnormal “liver function tests” on annual check-up or testing for other reasons.  Typically, it goes unnoticed without symptoms and is incidentally discovered.  Pain or discomfort around the area of the liver or right side of the abdomen is usually not due to fatty liver and a search for other causes of pain should be investigated.  The most common blood tests used to investigate the presence of liver disease are the serum ALT (SGPT) and serum AST (SGOT).  These may be completely normal in the presence of fatty liver and should not be relied upon to confirm or exclude the diagnosis. The presence of certain “red flags” such as diabetes and being overweight should trigger a diagnostic work-up with a liver ultrasound to make the diagnosis with confidence.

To know the extent of damage from excess fat accumulation in the liver, a new method using transient elastography (Fibroscan) is now available to determine the amount of scarring or fibrosis in the liver.  It is a quick, painless and reliable test which can give your doctor valuable information in assessing the degree of damage in your liver.

Will losing weight help treat fatty liver?
There is no single drug known to be better than weight loss and lifestyle change in treating this condition.  Supplements, popularly known as “liver vitamins” have not been proven by good scientific evidence to be effective in treating fatty liver disease.  It only gives patients a false sense of security and distracts their attention from doing what matters. Until there is good evidence to support the use of these medications, the use of these liver vitamins is of no proven benefit.  In fatty liver, the hardest thing to do is usually the one that works.  Unfortunately, there are no easy short cuts but is definitely worth doing.

How can people with fatty liver safely lose weight?

To lose weight is the most overused doctor advice. Not only is it overused, it has been proven to be the most difficult for many but undoubtedly one of the most effective.   Weight loss is more readily achieved and sustained when supervised by a professional.  The extent of weight loss and the time it takes to achieve the desired ideal weight are both important.  Gradual loss of weight until ideal body weight is achieved should be the ultimate objective. However, it should be kept in mind that this goal should be accomplished under the supervision and advice of professionals who know fatty liver disease.