Deepa Shah, MD, an HonorHealth gastroenterologist, discusses an increasingly common condition called fatty liver disease.
Q. What is fatty liver disease?
A. Non-alcoholic fatty liver disease is a condition caused by fat deposits in the liver. This can result in inflammation in the liver and fibrosis (the formation of excess fibrous connective tissue) and can lead to cirrhosis — late-stage scarring of the liver.
Fatty liver disease has two subtypes:
- Non-alcoholic fatty liver disease: A milder form of the disease, it involves fat in the liver but no inflammation.
- Non-alcoholic steatohepatitis: There's fat in the liver as well as inflammation. This subtype is diagnosed either by liver biopsy or imaging evidence of greater than 5 percent liver fat in individuals who consume little or no alcohol. No other cause for liver disease is apparent.
Q. I've never heard of this disease? Is it rare?
A. Non-alcoholic fatty liver disease is the leading cause of chronic liver disease in the U.S., afflicting 80-100 million Americans. The condition also is seen worldwide.
Q. Is this a dangerous condition?
A. It can be because it has the capability to develop into cirrhosis and liver cancer. It's also becoming one of the leading causes of liver transplant in this country. In fact, it is the third leading indication for liver transplant in the United States.
Q. Does drinking too much alcohol cause fatty liver disease? Or is it caused by eating too much fat in your diet?
A. The way fatty liver disease develops hasn't been fully determined. The most common theory is that insulin resistance causes the disease and inflammation of the liver.
Fatty liver disease is a manifestation of too much triglyceride accumulation in the liver. The disease is not necessarily caused by eating too much fat in the diet, but having an unhealthy diet can predispose you to having the condition.
If you eat too many carbohydrates and proteins, they can be converted to triglycerides. These are stored in the fat cells, and can be deposited in the liver. Insulin resistance can lead to increased triglycerides and increased uptake of fatty acids in the liver, causing further accumulation of liver triglycerides.
Drinking too much alcohol does not cause this condition, but it can cause inflammation in the liver to get worse. Fatty liver disease also can be a risk factor for development of cirrhosis. If you have this condition, you shouldn't drink alcohol.
Fatty liver disease is typically associated with other conditions including obesity, high blood pressure, diabetes, insulin resistance and hypertriglyceridemia.
Q. Does the disease run in families?
A. Although we're not sure if there is a hereditary component to this condition, there are ethnic differences in the prevalence of this condition. It's found more commonly in Asian Indians and Hispanics.
Q. How do you know if you have fatty liver disease?
A. Most people who have the condition do not have symptoms. Fatigue, vague right-upper-quadrant abdominal discomfort, and a generalized feeling of discomfort have been reported with this condition. It's most commonly diagnosed incidentally by elevated enzymes (transaminases) in blood tests, or detected by an abdominal ultrasound.
Fatty liver disease is associated with obesity, high blood pressure, insulin resistance, diabetes and lipid abnormalities. If you have some of these risk factors, it's probably a good idea to get screened for this condition by having a blood test with a liver panel.
Q. Does it cause itchy skin?
A. It can, if the bilirubin is elevated. If you have cirrhosis, there's a higher likelihood to have itchy skin.
Q. Is your liver the only organ that can get fatty?
A. No, other organs can, too.
Q. Is fatty liver disease something you can take care of yourself, or do you need a doctor's help?
A. It should be managed by a physician. The only proven treatment at this time is weight loss and good control of diabetes, hypertension and cholesterol. You might be a candidate for bariatric surgery to help with the weight loss. A 10 percent weight loss will lead to resolution of non-alcoholic steatohepatitis in 90 percent of people. Forty-five percent will have an improvement in the fibrosis stage.
There are no approved therapies for non-alcoholic steatohepatitis and related fibrosis. However:
- Vitamin E can be beneficial in patients without evidence of diabetes or cardiac disease
- Other medications have been used to help with treatment of diabetes
- Many medications are under development
- Some experimental endoscopic therapies also are available
The reason this condition should be managed by a physician, and in particular, a gastroenterologist or hepatologist (liver specialist), is that fatty liver disease has the potential to develop into cirrhosis and could require a liver transplant. However, if you lose weight, this condition often can improve tremendously.
You also should:
- Control your diabetes
- Control high cholesterol
- Avoid alcohol
You'll also have cardiovascular disease risk factors that need to be addressed.