Building up of fat in the liver is known as a fatty liver. There is some amount of fat in the liver which is normal for a healthy individual, but excessive fat accumulation in the liver can be a matter of serious concern.
The liver is an important organ which performs various necessary functions. It is the second largest organ in the human body and performs the function of processing the food and water that the body intakes and filters the unwanted and harmful substances from the blood. This function of the liver might be compromised if there is excessive fat accumulation in the liver. In this condition, vacuoles of triglyceride fats are present in the cells of the liver because of the abnormal lipid retention in the cells. When the fat metabolism process is disturbed it leads to the accumulation of high amounts of fat which results in a fatty liver.
Fatty liver can be an indicator of serious conditions if left untreated. Collection of fat cells in the liver is termed steatosis. In case inflammation is caused in the liver tissue because of these excess fat cells, the condition is known as steatotic hepatitis which should be taken seriously. A major cause of steatotic hepatitis is alcohol consumption or conditions which cause biochemical changes in the body. In case the problem is because of reasons other than alcohol, it is known as Non-Alcoholic Steatotic Hepatitis or NASH.
In case there is inflammation of the fatty liver, it can lead to scarring and also fibrosis of the liver. This is a serious condition which is known as cirrhosis and can lead to difficulties if left untreated.
This condition is reversible and can most often be taken care of by making healthy changes in one’s lifestyle. Fatty liver shows no signs in most of the cases and does not lead to any permanent damage to the liver in most of the cases unless the situation worsens or progresses. This condition can also become hazardous in case the underlying cause is not timely recognized and treated.
Grades/Stages of Fatty Liver
Fatty liver is most often not a serious and critical condition. The levels of development of the disease are divided into three grades, Grade 1, Grade 2 and Grade 3. Each one of these stages is related to different signs and symptoms which become severe as the disease progresses. The first two stages can be handled with proper medicinal treatment but treating grade 3 fatty liver might be more challenging.
Fatty liver grade 1 is the onset of the disease. It is the beginning stage of accumulation of fats in the liver. The symptoms in this stage are not severe and it is not serious in most cases.
Fatty liver grade 2 is the situation when the amount of fat accumulation in the liver increases. As the level of the fat cells increases in the liver, the liver starts decreasing its functionality. Due to the invasion of fats into the cells of the liver, the cells that are responsible for carrying out different functions start dying. Medical attention is necessary at this stage.
Fatty liver grade 3 is the most severe and serious form of the condition. At this stage, the fat accumulation has spread to the entire liver. The liver becomes inflamed and the situation worsens. The blood vessels in the liver are not able to perform the function of pumping in the nutrients and pumping out toxins. Distension of the abdomen might also appear. The normal cells of the liver start fading and fibrotic cells start appearing. Significant diet changes are made at this stage. Fatty foods and red meat products should be avoided. Industrial cooking oils should not be used and should be substituted by coconut oil, flaxseed oil, sunflower oil etc. Intake of fresh fruits and vegetables should be increased.
Risk Factors of Fatty Liver
The condition of fatty liver is due to the building up of more than normal fats in the liver. It is more prevalent in individuals who are obese or are overweight. Individuals suffering from Type 2 diabetes are also at a higher risk of developing fatty liver. Accumulation of fat is often connected to resistance to insulin which is the main cause of development of type 2 diabetes.
Other factors that are associated with the development of the condition are consumption of alcohol in excessive quantities, high levels of triglyceride fat cells in the body, a high level of cholesterol, high blood pressure patients taking long-term medicines for the condition, taking higher than usual and/or recommended dosage of some over the counter medicines like Tylenol etc. The risk is also heightened during pregnancy. Fatty liver might also affect individuals experiencing malnutrition. The condition of metabolic syndrome is also associated with the development of fatty liver.
Symptoms of Fatty Liver
Beginning stage of fatty liver disease generally shows no symptoms. Mild cases of fatty liver are mostly asymptomatic. Fatigue and abdominal discomfort might be experienced by the individual. This condition is usually uncovered during routine check-ups and physical examination. The liver might become enlarged which is detected by a physical examination.
Some people might experience vague symptoms such as fatigue even with little or moderate physical exertion, wanting to rest because of the feeling of discomfort, heaviness and fullness in the abdomen mostly in the upper right corner etc. Sometimes applying pressure might result in pain in the liver area. Liver inflammation might cause signs like confusion, pain in the abdomen, loss of weight, a poor appetite, weakness and fatigue etc.
If left unchecked and untreated, the fatty liver might transform into cirrhosis which is a serious and life-threatening condition. Symptoms of this condition include easy bleeding tendency, confusion, enlargement of the abdomen, fluid in the abdomen, symptoms of jaundice like dark coloured urine, yellow colour of the skin start appearing, inability of blood to clot, fine tremors of the fingers, poor memory and concentration, distending of veins in hands and legs, nausea, vomiting, loss of appetite, giddiness etc.
Causes of Fatty Liver
Most often the fatty liver disease occurs in people who indulge in heavy drinking and their alcohol intake is higher. Though, it might occur in people without any drinking problems.
There are various causes other than alcohol for the occurrence of fatty liver disease. These include metabolic syndromes which lead to an imbalance in the metabolic capacity in the body like glycogen storage diseases, acute fatty liver of pregnancy, abetalipoproteinemia, Weber-Christian disease etc. Other conditions like diabetes, high blood cholesterol, high blood pressure, Wolman’s disease, Galactosemia, Wilson’s disease and infections like tuberculosis and malaria are also known to be causes of fatty liver disease.
Various nutritional causes like obesity, malnutrition, sudden weight loss, gastric bypass, total parenteral nutrition, refeeding syndrome, jejunal diverticulosis with overgrowth of bacteria, jejunoileal bypass etc. are also some of the factors aiding in the development of the fatty liver disease.
Certain drugs like Valproic acids used in epilepsy, Sedatives, Anti-retroviral drugs, corticosteroids, methotrexate, Vitamin A overdose, Tamoxifen which is used in the treatment of breast cancer, medications like amiodarone and diltiazem which are used in treatment of heart conditions like high blood pressure and irregular heartbeats environmental hepatotoxins like phosphorous and mushroom poisoning are also some causes of fatty liver disease. Inflammatory bowel disease, hepatitis C particularly genotype 3, HIV, Celiac disease and alpha 1- antitrypsin deficiency can also be the cause of the development of a fatty liver.
Most often the diagnosis of fatty liver is incidental. Most of the individuals suffering from this condition are asymptomatic and the disease is uncovered through incidental abnormal tests like liver function tests or hepatomegaly done for other medical conditions that are unrelated. There is no particular test that can show whether the accumulation of fats in the liver is because of alcohol use or other factors. Thus, the doctor will inquire about the alcohol consumption habits of the individual to establish the reasons. This information helps the physician in determining whether the condition is ALD or NAFLD.
Various tests can be used by the healthcare practitioner to diagnose the disease. Some of the tests used are-
Physical Examination: In case of inflammation of the liver, the doctor can detect it by the examination of the abdomen for any enlargement of the liver. The doctor needs to be informed if the patient is experiencing fatigue, loss of appetite etc. The doctor also enquires about the alcohol history, medications and the history of supplement usage.
Blood tests: Blood tests might reveal high levels of liver enzymes in routine tests. Abnormal liver enzymes level in the blood give a deeper understanding of the cause of the disease as well as is an identifier of the problem. Liver function tests also provide an understanding of the efficiency of the treatment and the improvement that can be expected. But, this test does not fully confirm the diagnosis. A further analysis of the situation is necessary.
Imaging studies: Ultrasounds can also be conducted to diagnose the problem of fatty liver. It is a painless and a non-invasive test and can most often detect the condition accurately. The fat in the liver shows as a white patch on the ultrasound image.
Computed Tomography scan also knows as CT scan can also be performed as it can measure the organs and the inflammation accurately through the use of X-Rays. MRI or Magnetic Resonance Imaging can also be used to scan the internal organs. But these tests cannot confirm whether the individual has a simple fatty liver or NASH. Another kind of imaging study is a FibroScan, which helps in determining liver density and the fat tissues and normal tissues areas.
Liver Biopsy: In liver biopsy is performed, a needle is inserted into the liver for removal of tissue for examination. Anaesthetics are given to the patient to relieve the pain. Through a liver biopsy, the doctor can certify of the disease and also know the cause of the condition.
There is no set method of treatment for fatty liver. Undergoing treatment for the underlying cause of the problem can help reverse the changes that have happened in the liver. Reducing the risk factors is often recommended. Some of the most common recommendations that are prescribed are:
Controlling cholesterol levels: Reducing the number of saturated fats in the diet can be a healthy approach which can help control and reverse the situation. Also, medications that lower cholesterol levels are also prescribed which can be used along with exercise and regular workouts to reduce and reverse fatty liver.
Exercise and Weight loss programs: The objective of these programs should be to lower the body mass index of the patient by around two units in comparison to the existing BMI. Aerobics is an effective way to burn off excess fat in the body. In order to reap long-term benefits, dedication and sustenance matter more than the intensity of the workout.
Controlling Diabetes: Lifestyle changes are required to move towards a healthy body and control diabetes. Management of sugar levels in the body can be done by taking proper medication. Controlling diabetes can stop the disease from advancing to the more stage of cirrhosis or failure of the liver.
Avoiding harmful substances: Substances like alcohol, certain drugs and fatty junk foods should be avoided to prevent the condition from advancing. Certain medications which can cause complications should also be substituted by consulting with a healthcare practitioner.
Protecting the liver from harmful substances is the most important way to avoid the occurrence of fatty liver. The reduction in alcohol consumption is the most important method to eliminate the risk of fatty liver. Smoking should also be reduced as it leads to various biochemical and hemodynamic changes which can cause liver damage.
A proper check should be kept on the weight. A healthy routine of exercising and a healthy balanced diet should be followed to maintain a healthy weight. Omega 3 fatty acids have been shown to prevent fatty liver. It is found in various natural sources like fish oils, walnuts and flaxseed oils. Leading a healthy lifestyle is the key to a healthy body.