Fatty Liver Disease

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Fatty liver disease is the build-up of excess fat in the liver cells. It affects about one in every 10 people. It is normal for the liver to contain some fat, but if fat accounts for more than 10 per cent of the liver’s weight, then you have fatty liver and you may develop more serious complications.

Fatty liver may cause no damage, but sometimes the excess fat leads to inflammation of the liver. This condition, called steatohepatitis, does cause liver damage. Sometimes, inflammation from a fatty liver is linked to alcohol abuse. This is known as alcoholic steatohepatitis. Otherwise, the condition is called non-alcoholic steatohepatitis, or NASH.

Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is an accumulation of excess fat in the liver of people who drink little or no alcohol. The liver cells swell up due to deposition of fat and liver is enlarged is size and is bright on echotexture on an ultrasonography examination. Individuals with this condition are labeled as having a fatty liver. In a small percentage of people fat leads to oxidative damage to the liver called as non-alcoholic steatohepatitis (NASH). Long standing NASH leads to increased liver stiffness called fibrosis which when advanced causes permanent end stage liver disease called cirrhosis.


The majority of individuals with NAFLD have no symptoms and a normal examination. Fatty liver is most of the times incidentally detected when getting an ultrasound examination for some other cause or if the liver function tests (SGOT/SGPT) on a routine annual examination are abnormal. Some persons may complain of a dull right sided upper abdominal pain due to the stretch of the liver capsule in fatty liver.

Causes of fatty liver disease

Eating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as obesity, diabetes or high triglycerides.

Alcohol abuse, rapid weight loss and malnutrition may also lead to fatty liver. However, some people develop fatty liver even if they have none of these conditions.

NAFLD is part of the metabolic syndrome characterized by diabetes, or pre-diabetes (insulin resistance), being overweight or obese, elevated blood lipids such as cholesterol and triglycerides, as well as high blood pressure and hypothyroidism.

Diagnosis of NAFLD/NASH

As mentioned earlier, NAFLD/NASH is incidentally picked on routine ultrasound examinations or blood tests. The causes of fatty liver due to contributing metabolic conditions have to be investigated thoroughly. NASH has to be distinguished from other serious causes of liver enzyme derangements like alcoholic hepatitis, chronic hepatitis B and C and autoimmune hepatitis. Non-invasive methods like Fibroscan or invasive methods like liver biopsy are occasionally needed to determine the severity of liver stiffness.

Treatment of NAFLD/NASH

NAFLD is a lifestyle disease. Maintaining a healthy lifestyle with normal weight as per body mass index, controlling diabetes and cholesterol through diet and medication, controlling blood pressure and maintaining normal thyroid levels helps to reduce fatty liver. Aerobic exercise daily is of utmost importance.

Development of medications that could treat NAFD and NASH is an area of intense research. Recent trials in adult and children have shown that vitamin E (an anti-oxidant) could help improve NASH.