Fatty liver disease

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Overview

Nonalcoholic fatty liver disease (NAFLD) affects 25% of people worldwide. Patients with fatty liver disease are primarily asymptomatic. Currently, specialists are predicting that fatty liver related cirrhosis will the be leading reason for liver transplants in the next 10-20 years, displacing hepatitis C and alcohol related liver transplants. NAFLD exists on a spectrum of simple steatosis to steatosis with inflammation and different levels of fibrosis. It is currently estimated that 20% of simple steatosis patients will progress to nonalcoholic steatohepatitis (NASH). Patients with NASH are at risk for further progression to cirrhosis and hepatocellular carcinoma. There is no single factor that triggers progression from simple steatosis to NASH, however, we do know that NASH is more prevalent in patients with obesity, diabetes, and metabolic syndrome. NAFLD is thought to be the hepatic manifestation of metabolic syndrome, and is closely tied with hyperinsulinemia. Currently there are no approved FDA treatments for NAFLD. NAFLD is typically found incidentally on imaging such as abdominal ultrasound and CT. Elevations in alanine aminotransferase (ALT) may prompt the clinician to evaluate for NAFLD however ALT should not be used as a diagnostic tool. The gold standard for diagnosis of NAFLD and NASH is a liver biopsy. Only a liver biopsy can distinguish simple steatosis from NASH. In patients whom NAFLD is suspected, appropriate biochemical assessment and imaging should be evaluated. Also, the presence of fibrosis should be assessed. Weight loss and dietary modifications are currently the only recommendations provided to NAFLD patients. There is histological improvement seen in in patients whom lose 5-10% of their body weight. Certain dietary factors play a role in the development of NAFLD including excessive caloric intake and high fructose consumption. There are pharmacological treatments currently being studied as well as non-pharmacological agents. This overview focuses on evaluation, management and treatments in NAFLD.


Symptoms

Abdominal pain or a feeling of fullness in the upper right side of the abdomen (belly).

Nausea, loss of appetite or weight loss.

Yellowish skin and whites of the eyes (jaundice).

Swollen abdomen and legs (edema).

Extreme tiredness or mental confusion.

Weakness.

Causes

Overweight or obesity.

Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin.

High blood sugar (hyperglycemia), indicating prediabetes or type 2 diabetes.

High levels of fats, particularly triglycerides, in the blood.

Risk factors

High cholesterol.

High levels of triglycerides in the blood.

Metabolic syndrome.

Obesity, particularly when fat is concentrated in the abdomen.

Polycystic ovary syndrome.

Sleep apnea.

Type 2 diabetes.

Underactive thyroid (hypothyroidism)

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Complications

Extrahepatic complications of NAFLD include chronic kidney disease, extrahepatic malignancies (such as colorectal cancer), psychological dysfunction, gastroesophageal reflux disease, obstructive sleep apnea syndrome, periodontitis, hypothyroidism, growth hormone deficiency, and polycystic ovarian syndrome.

Prevention

The best way to avoid fatty liver disease is to do the things that maintain overall health:


Stay at a healthy weight. If you’re overweight or obese, lose weight gradually.

Exercise regularly.

Limit your alcohol consumption.

Take medications as prescribed.

Choose a healthy plant-based diet that's rich in fruits, vegetables, whole grains and healthy fats. Maintain a healthy weight. If you are overweight or obese, reduce the number of calories you eat each day and get more exercise.