Everything You Need to Know About Fatty Liver Disease

The liver truly is a remarkable organ. As our body’s detoxifier, it filters out all sorts of toxins every day, helping us stay healthy. Unfortunately, the liver is not invincible, and fatty liver disease (FLD) can be a real threat to our well-being. This disease occurs when there is a buildup of fat in the liver. With its ability to quietly develop over many years without causing obvious symptoms, FLD has gained the reputation as a “silent epidemic”. Furthermore, many people are unaware of this severe condition and its various forms. Today, we will answer the question, “What is fatty liver disease,” and delve into its causes, symptoms, treatment options, and more.

What is Fatty Liver Disease?

The liver is the largest organ within the body, which helps us digest food, store energy, and remove toxins from the body. However, a condition called fatty liver disease can put this organ in danger. This disease occurs when too much fat accumulates in the liver, which, if left untreated, can cause serious health problems such as cirrhosis (scarring) and liver failure. It is mainly caused due to heavy alcohol consumption or due to certain medical conditions such as diabetes. FLD is of two main types: nonalcoholic and alcoholic, but it also occurs in other forms.

Although the condition can be asymptomatic in its early stages, diagnosing and managing it early on is essential. With proper diet changes, exercise, and medication, fatty liver disease can be prevented and managed effectively.

Symptoms of Fatty Liver Disease

Fatty liver disease, also called steatosis liver disease (SLD), doesn’t always show symptoms and is usually a silent disease with few or no symptoms. It usually progresses through four main stages. These are:

• Simple Fatty Liver: Excess fat builds up in the liver but is generally harmless unless it progresses further.
• Steatohepatitis: Along with excess fat, inflammation occurs in the liver.
• Fibrosis: Inflammation leads to scarring, but the liver can still function relatively well.
• Cirrhosis: Widespread scarring impairs the liver’s function, making this stage the most severe and irreversible.

People notice fatty liver symptoms once it has progressed to cirrhosis, which is when they may experience:

• Swollen belly
• Enlarged blood vessels
• Enlarged spleen
• Yellowing of skin and eyes (jaundice)
• Dark-coloured urine
• Pale stools
• Swelling in the abdomen (ascites)
• Edema
• Bleeding in the oesophagus, stomach, or rectum
• Nausea
• Loss of appetite
• Unexplained weight loss
• Malaise
• Larger-than-normal breasts in men
• Red palms
• Nausea
• Tiredness or fatigue
• Mental confusion

If you experience any of these symptoms, meet your doctor as soon as possible. This is because cirrhosis causes permanent liver damage, which can impact your quality of life. You can stop fatty liver from progressing and causing complications by following a doctor’s recommended treatment plan.

Causes of Fatty Liver Disease

So, what causes fatty liver disease? Chronic alcohol use is one of the main culprits behind FLD. Consuming too much alcohol can alter certain metabolic processes in the liver and cause Alcoholic Fatty Liver Disease (AFLD), a type of FLD. When these metabolic products combine with fatty acids, they form fat that can accumulate in the liver.

Other conditions that cause FLD include:

• Metabolic syndromes like insulin resistance, high cholesterol and high triglycerides
• Type 2 diabetes
• Obesity
• Polycystic ovary syndrome (PCOS)
• Obstructive sleep apnea
• Hypothyroidism (low levels of thyroid hormones)
• Hypopituitarism (low levels of pituitary gland hormones)
• Hypogonadism (low levels of sex hormones)

Other potential causes of fatty liver disease:

• Pregnancy (very rarely)
• Side effects from some types of medications, including amiodarone, diltiazem, tamoxifen, or steroids, build up fat in your liver.
• Infections such as hepatitis C
• Certain rare genetic conditions

Risk Factors Associated with Fatty Liver Disease

The main risk factor for developing Alcoholic Fatty Liver Disease (AFLD) is heavy alcohol consumption. Heavy drinking is defined in terms of grams of alcohol consumed or the number of drinks consumed weekly. To clarify, a standard drink contains about 14g of alcohol. Thus, heavy drinking is defined as:

• 15 or more drinks per week for men, or 40–80 grams (g) of alcohol per day
• 8 or more drinks per week for women or 20–40 g of alcohol per day

Other risk factors include:

• Being overweight
• Being malnourished
• Have chronic viral hepatitis C
• Insulin resistance due to type-2 diabetes
• High amounts of triglycerides or Low-density lipoprotein (LDL) cholesterol or reduced levels of good High-Density lipoprotein (HDL) cholesterol
• Rapid weight loss
• Exposure to harmful toxic fumes of chemicals

Some less common reasons factors to develop nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) include:

• Medical conditions affecting fat storage
• Hepatitis C infection
• Taking certain medicines like glucocorticoids, methotrexate, synthetic estrogen, and others
• People who have undergone surgery to remove their gallbladder are more likely to develop NAFLD

It is not necessary that having a single risk factor can cause fatty liver disease, but it does increase your chances of developing it. If you have one or more risk factors for FLD, speak to your doctor about prevention strategies.

Types of Fatty Liver Disease

FLD is classified based on the causes and the conditions associated with the fatty liver. These include:

• Nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) is one type of fatty liver disease that is not associated with alcohol use. There are two kinds:

• Simple fatty liver: This happens when you have too much fat in your liver but little or no inflammation that can still cause liver damage or complications.
• Nonalcoholic steatohepatitis (NASH): This occurs when your liver exhibits inflammation, fat deposition, and liver cell damage that may further cause fibrosis or scarring. In later stages, it may lead to cirrhosis or liver cancer.

• Alcoholic fatty liver disease (AFLD)

Alcoholic fatty liver disease (AFLD), also called alcoholic steatohepatitis, occurs due to heavy consumption of alcohol. In general, the liver breaks down most of the alcohol you consume. It generates harmful substances during this process that can harm the liver cells, promote inflammation, and weaken the body’s natural defences. The more alcohol you drink, the more damage it causes to your liver.

• Metabolic dysfunction-associated steatotic liver disease (MASLD)

MASLD is known to be a non-alcohol-related fatty liver disease (NASLD). The risk factors for this disease include:

• Obesity
• Type 2 diabetes
• High blood pressure
• Lipid abnormalities

• Metabolic-associated steatohepatitis (MASH)

Metabolic-associated steatohepatitis (MASH) is a serious form of MASLD in which fat buildup causes inflammation, tissue damage, and scarring in the liver.

• MASLD and increased alcohol intake (termed MetALD)

One more type of FLD is MetALD, in which both metabolic risk factors and alcohol consumption can build up fat in your liver. The amount of risk for liver damage varies from person to person.

• Cryptogenic SLD

Sometimes, healthcare providers cannot identify the cause of steatosis liver disease and call it cryptogenic SLD.

Diagnosis of Fatty Liver Disease

The diagnosis of fatty liver starts with a health history and physical examination because most people don’t have symptoms. The doctor uses different methods to diagnose the condition, which include:

Health history and physical exam

The doctor will first ask about your alcohol use, which will help them figure out the extent of the disease. Your doctor may check for signs of liver issues, such as an enlarged liver or jaundice. They may assess your height and weight to calculate body mass index (BMI), which will help determine the chances of developing a fatty liver.

Blood tests

The following blood tests are conducted for fatty liver disease:

• Liver function tests to detect and monitor liver damage, if any.
• Fibrosis assessment tests to estimate the level of liver scarring.
• Lipid profile test that measures lipid content in the blood, such as cholesterol and triglycerides.
• Other blood tests for hepatitis C and Wilson disease (a rare genetic condition).
• Haemoglobin A1C, determines how stable your blood sugar is.

Imaging tests

The doctor may ask for an ultrasound, computerised tomography (CT) scans, or even magnetic resonance imaging (MRI) reports to check how much fat is present in the liver. But these tests can only tell if there is fatty liver and cannot discriminate between simple fatty liver and NASH.

Some tests can detect fibrosis by assessing the stiffness of the liver. When liver cells usually die, they’re replaced by scar tissue, which is stiff. The stiffer the liver is, the more scarring it has.

• Transient elastography is done to measure liver stiffness using a special ultrasound machine named pulse-echo ultrasound acquisitions to measure liver stiffness.
• Magnetic resonance elastography (MRE) combines ultrasound and MRI to visually map stiffness caused by inflammation and fibrosis in chronic liver diseases.

Liver biopsy

A doctor may need to conduct a liver biopsy if you’re at risk for NASH or if the doctor suspects liver cirrhosis. Here, a doctor extracts a sample of liver tissue and sends it to a lab for examination to look for liver inflammation or damage in the lining of the liver.

Treatment of Fatty Liver Disease  

There’s no specific fatty liver treatment or medication. Instead, doctors guide you to focus on helping you manage risk factors that contribute to the condition of fatty liver, including lifestyle modification and certain medications.

Your healthcare provider may recommend that you:

• Avoid consumption of alcohol: The most crucial part of alcohol-related fatty liver disease treatment is to stop drinking alcohol entirely. You may need a therapist or participate in an alcohol recovery programme to break this habit. Some medicines can help to reduce your craving for alcohol. The doctor will advise you to steer clear of alcohol even if your FLD isn’t related to alcohol use.
• Lose weight: Exercising and changing your eating and drinking patterns under a nutritionist’s supervision can help you lose weight. Certain medications, such as GLP1RA, can also help you lose weight. Doctors may also suggest bariatric surgery to lose weight in a few cases.
• Take medications to manage metabolic conditions: Certain medicines can help you with the metabolic process to manage diabetes, cholesterol, and triglycerides (fat in the blood).
• Get vaccinated for hepatitis A and B: Viral infections like hepatitis A and hepatitis B make your body more vulnerable to disease, including liver disease.

Lifestyle Changes Recommended for Fatty Liver Disease

The first-line treatment for fatty liver disease includes treatment that focuses on lifestyle changes like weight loss, dietary control, and increased physical activity. These modifications are similar to the recommendations for metabolic syndrome. They may also be applied for NAFLD, which controls blood glucose, blood pressure, triglycerides, and HDL levels.

The doctor may recommend specific lifestyle changes depending on your condition and lifestyle habits, which include:

• Weight loss
• Reduction or abstention from alcohol consumption
• Taking a nutrient-rich diet with fewer calories, low saturated fat, and trans fats
• Doing 30 minutes of exercise on most of the days
• Taking vitamin E supplements might help improve alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and reduce liver inflammation.

However, it is always recommended to consult a doctor before you try any new supplement, as they might place stress on your liver or may interact with any ongoing medications.

Diet for Individuals with Fatty Liver Disease

If you have fatty liver disease, the doctor will advise you to make certain changes to treat your condition and lower its complications, including:

• Balance your diet: A balanced diet can help lower the risk of forming fatty liver disease. So, selecting foods from all food groups, like fresh fruits and vegetables, whole grains, lean proteins, low-fat dairy and healthy fats and oils, is recommended.
• Cut calories: You must always aim to reduce your consumption of foods that are high in calories to maintain a healthy weight.
• Focus on fibre: Increasing the uptake of fibre-rich food in the diet, like millet, fresh fruits and vegetables, legumes, and whole grains, can help improve the function of your liver.
• Limit certain foods: People living with fatty liver disease should cut down on certain foods like:
  • Sodium (salt)
  • Refined carbohydrates present in sweeteners, white rice and bread, or other refined grain products
  • Saturated fats present in red meat, full-fat dairy, and fried foods
• Limit alcohol: Talk with a doctor about whether you can have alcohol or not because people with serious liver conditions like AFLD should completely abstain from drinking alcohol entirely.
• Drink water: Staying hydrated by drinking lots of water can help keep your liver hydrated, which can help improve its health.

How can Fatty Liver Disease be Prevented?

Some general tips to prevent FLD tips include:

• Limiting or avoiding the use of alcohol even if your SLD isn’t related to alcohol use.
• Managing your weight by eating a balanced diet, i.e., one that is rich in nutrients and low in saturated fat, trans fat, and refined carbs.
• Taking steps to manage and monitor your blood sugar, triglyceride levels, and cholesterol levels as a rise in blood sugar is linked to fatty liver disease.
• Increasing uptake of fibre-rich food in the diet to help improve the function of your liver
• Doing 30 minutes of exercise on most of the days.

Conclusion

To sum up, fatty liver disease is a warning sign that can help you take steps to avoid a fatal liver condition like cirrhosis or liver cancer. The first form of treatment for fatty liver disease is to make lifestyle modifications to improve your liver health. For people dealing with Alcoholic Fatty Liver disease (AFLD), it is important to abstain from alcohol use entirely to prevent further damage to the liver. Lifestyle modifications and proper management of other medical conditions are crucial for people affected by other forms of FLD. Changes in an early stage can help you protect your liver, improve your health and prevent severe complications of this disease. Having health insurance ensures access to regular check-ups and necessary treatments, giving you peace of mind while managing your liver health effectively.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.