Fatty Liver Disease - Causes, Symptoms, Diagnosis, Prevention & Treatment

Managing Non-Alcoholic Fatty Liver Disease

Dr.Shamsudin  Mohamed Rela profile Authored by Dr.Shamsudin Mohamed Rela on 19 Jun 2014 - 16:03.

Non-Alcoholic Fatty Liver Disease (NAFLD) is characterized by excessive accumulation of fat in the liver. It is the commonest cause of abnormal liver function tests affecting 30 percent of the population around the world. It is much more common in patients with diabetes.

Almost 90 percent of patients with morbid obesity may have fatty liver. As India is the 'diabetes capital of the world' prevalence of fatty liver disorder may be much higher. In India, NAFLD has been described even in lean persons. Metabolic Syndrome associated with central obesity, diabetes mellitus, hypertension and high cholesterol is closely linked with NAFLD. When the liver is unable to metabolize excess fat in diet, it leads to fat accumulation causing fatty liver.

Like most chronic liver conditions, patients with NAFLD are asymptomatic until late in their illness. Even many patients with cirrhosis do not have symptoms. Majority of the patients are rather diagnosed incidentally, usually during a master health check-up. According to recent researches, NAFLD may increase the risk of having heart disease, especially in obese children.

Types of Non-Alcoholic Fatty Liver Diseases:

Types of non-alcoholic fatty liver disease range from harmless to life threatening. These types include:

  • Non-alcoholic fatty liver disease: It is relatively harmless and the most common stage of this disease and there are no symptoms or complications. This stage of disease is potentially reversible by diet and life style modifications.
  • Non-alcoholic Steatohepatitis: It is a more severe stage   in which prolonged inflammation of the liver causes scarring of the liver tissues and impairs the liver functions. 
  • Cirrhosis: Liver associated with NAFLD. Liver is permanently damaged, is scarred  and leads to permanent liver damage (liver failure).

Diverse range of causes may contribute to the development of NAFLD. Some commonly recognized causes are:

  • Certain drugs and medications-Amiodarone, Corticosteroids, Tamoxifen, Methotrexate, Sodium Valproate,  medications for treating HIV disease,
  • Hepatitis (A, B, C, D, and E)
  • Autoimmune liver diseases
  • Inherited liver abnormality-Wilson’s disease, Lipodystrophy, Abetalipoproteinemia.
  • Sudden weight loss
  • Malnutrition / unhealthy diet- This may mean excessive or poor intake. Both extremes can cause fatty liver disease.
 

Most of the patients having NAFLD do not display any symptoms, unless it is severely damaged. Some patients with severely damaged liver may have the following symptoms:

  • Extreme tiredness or weakness
  • Abdominal discomfort, especially in the upper right abdomen
  • Enlargement of the liver (more than normal size)
  • Nausea
  • Mental imbalance causing confusion, lack of ability to judge the situation or lack of concentration.
  • Patchy skin.
  • Discoloration of the skin (especially on the neck and underarm area)

Unfortunately, several patients by the time they present to the doctor have advanced disease such as cirrhosis and liver failure. Jaundice, altered consciousness, fluid accumulation in the abdomen (ascites) and legs, vomiting blood and passing black stools are seen in patients with end stage liver disease.

Most patients by this time become too weak to perform their day to day activities. In addition, presence of cirrhosis increases the risk of primary liver cancer (hepatocellular carcinoma) significantly by several folds.

 

Diagnosis:

Diagnosis of NAFLD includes following tests and examinations:

  • Liver function tests: This involves assessment of a blood sample to trace out any abnormal sign indicating liver disease. These may include looking for level of enzymes like alanine aminotransferase (ALT) or aspartate aminotransferase (AST).
  • Imaging tests: To detect the inflammation or scarring of the liver. Imaging modalities like ultrasound, magnetic resonance imaging (MRI) or computerized tomography (CT) scan may be used.
  • Liver biopsy: This includes examining the extracted tissue of affected liver under microscope to detect any sign of abnormality.

 

Risk factors:

Having certain conditions may increase the risk of having NAFLD. Some common factors are:

  • Weight loss surgery (Gastric bypass surgery)
  • Elevated cholesterol level
  • Elevated levels of triglycerides in the blood
  • Metabolic disease-Diabetes mellitus, Systemic hypertension, Central obesity etc.
  • Being overweight
  • Polycystic Ovary Disease (PCOD)
  • Sleep apnea
  • Thyroid abnormalities like  Hypothyroidism
  • Hypopituitarism

 

There is no ideal treatment for NAFLD. Instead, risk factors contributing to the disease are often targeted. In addition, patients may have to practice certain lifestyle interventions, home remedies and some alternative therapies.

Lifestyle interventions:

Life style modification is the most important aspect of NAFLD treatment. This involves weight loss through change in dietary habit and exercise, in those who are obese. Weight loss of 5-10 percent over 6 months has been shown to improve NAFLD and obesity. Rapid weight loss paradoxically exacerbates NAFLD and is hence not recommended.

Following lifestyle interventions can help to control the nonalcoholic fatty liver disease:

  • Eat healthy:High calorie intake significantly contributes to the development of fatty liver disease. Therefore, diet rich in carbohydrates and saturated fats should be avoided. Most fast-foods and aerated soft drinks cause or worsen liver injury due to fatty accumulation and should be avoided.

    Polyunsaturated fatty acid (PUFA) may improve liver enzymes and are recommended. Diet with low glycemic index, rich in fruits & vegetables with limited red meat consumption are recommended.
  • Exercise regularly: Exercise such as brisk walking, jogging or swimming helps weight reduction, improvement in liver enzymes and decreases the risk of diabetes.

    Moderate exercise with expenditure of at least 400 calories for 3-4 times a week improves NAFLD in the short term.
  • Control your diabetes by regular checkup and by following all the recommendations. Also, take medications as directed.
  • Maintain healthy cholesterol level eating vegetables, fruits, regular exercise and medications as directed.
  • Avoid alcohol consumption
  • Get yourself vaccinated for hepatitis A & B

Alternative Medicine

In reality, there is no alternative medicine that can cure NAFLD disease. However, according to experts some natural compounds may help to cope up with the condition. These include:

  • Vitamin E supplements: Vitamin E is believed to prevent liver damage by neutralizing the inflammation and scarring of the liver tissues. Unfortunately, benefits of vitamin E come along certain side effects like risk of prostate cancer. Thus, it is advised to take vitamin E supplements strictly under expert’s observation.
  • Coffee:It has been demonstrated that, drinking coffee reduces liver damage and progression of scarring. However, standard for the amount of coffee giving positive results is not clear. These results are seen in patients who were already drinking coffee and it is not recommended to start drinking the coffee for this reason.
  • Probiotic supplements: Dietary supplements (yogurt) with healthy live bacteria or yeasts may be beneficial for patients with NAFLD.

 

 

 

 

Following preventive measures can be implemented to reduce your risk of nonalcoholic fatty liver disease:

  • Eat healthy and balanced diet
  • Maintain a healthy weight
  • Exercise regularly (as recommended)
  • Get yourself vaccinated against hepatitis A and hepatitis B. This is likely to reduce additional liver injury risk that these viruses pose in patients with or at risk of  NAFLD.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.