Understanding Fatty Liver

by Dr. Shannon Cheffet

Fatty liver is a term you may have heard about more frequently in the last few years. In this short article, we wanted to help share the current knowledge of this condition and the fact that there is ongoing research into treatment options. Our liver is an organ in the right upper abdomen that functions to filter the blood from our digestive tract by detoxifying chemicals and metabolizing medications. The liver is also vital in making proteins that are needed for our clotting functions of the blood. There are many conditions that can affect liver function, however, in recent years, physicians have a growing concern about the increased number of fatty liver diagnoses in our patients.

What is Fatty Liver?
Fatty liver (also known as non-alcoholic fatty liver disease or NAFLD) is a condition that physicians are detecting in a rising number of patients. This condition is the one of three different stages of disease that can result in cirrhosis or scarring of the liver. The initial stage is when the liver has fatty build up within the tissues but there are no signs of inflammation. The second stage, non-alcoholic hepatosteatosis (NASH), is when there are excessive fatty deposits in the liver tissue with associated inflammation. NASH is the condition that can progress to the third stage, identified by fibrosis or scarring of the liver tissue, which can lead to cirrhosis.UCLA Health’s Center for Obesity and Metabolic Health states that systematic studies in the US show that the prevalence of fatty liver ranges from 25-33% and NASH ranges from 2-5%. With the rise in numbers in our communities, researchers are working to understand the many environmental or genetic influences which are felt to increase the risk of fatty liver. Known risk factors include insulin-resistance (pre-diabetes or diabetes), hyperlipidemia, abdominal obesity and hypertension. This condition is not a complication of chronic alcohol use, however, chronic alcohol use can increase the risk of liver inflammation and progression of this disease.

How it is diagnosed and treated.
Diagnosis can be determined using imaging studies, such as ultrasound, CT or MRI of the abdomen. Often, a persistent elevation in liver enzymes on routine blood work will suggest the need for imaging to determine if NAFLD is present. This condition is usually asymptomatic and does not always cause elevation of liver enzymes, making it more difficult to diagnose.The treatment options for NAFLD/NASH focus on prevention and lifestyle changes. Avoidance of alcohol is crucial to help prevent inflammation. Immunization against Hepatitis A and B is also recommended. The goal of therapy is to modify the risk factors by treating hypertension, hyperlipidemia and optimizing blood sugar levels. Since elevation in the Body Mass Index (BMI > 25) results in an increased risk of NAFLD, physicians will recommend diet and exercise. If this regimen is not effective after 6 months, drug therapy or bariatric surgery, also known as metabolic surgery, may be discussed if appropriate. There are ongoing studies for Vitamin E supplementation as well as other new pharmacologic treatment options for NAFLD and NASH.In summary, research is still uncovering the causes and potential treatments for this condition. However, it is vital for patients and their physicians to be aware of this condition and work together to modify the risk factors and focus on prevention. At Lifewellness, we monitor our patients for many chronic diseases, including fatty liver. If you have any concerns about this condition or would like to review for your risk, please let us know when booking your next appointment. We are happy to discuss it with you.