Fatty
Liver Disease
Some fat in the liver is normal. But if fat makes up more
than 5%-10% of the weight of your liver, you may have alcoholic or nonalcoholic liver disease. In some
cases, these diseases can lead to serious complications.
Alcoholic Liver Disease (ALD)
More than 15 million people in the U.S.
Fatty liver can occur after drinking moderate or large amounts of alcohol. It
can even occur after a short period of heavy drinking (acute alcoholic liver
disease).
Genetics or heredity (what is passed down from parent to
child) plays a role in alcoholic liver disease in two ways: It may influence
how much alcohol you consume and your likelihood of developing alcoholism. And,
it may also affect levels of liver enzymes involved in the breakdown (metabolism) of
alcohol.
Other factors that may influence your chances of
developing alcoholic fatty liver disease include:
·
Hepatitis C
(which can lead to liver inflammation)
·
An overload of iron
·
Obesity
·
Diet
Nonalcoholic
fatty liver disease (NAFLD)
Nonalcoholic fatty liver disease is now the most common
cause of chronic liver disease in the U.S.
Others have what's called nonalcoholic steatohepatisis
(NASH). Although it is similar to alcoholic liver disease, people with this
type of fatty liver disease drink little or no alcohol. NASH can lead to
permanent liver damage. The liver may enlarge and, over time, liver cells may
be replaced by scar tissue. This is called cirrhosis. The liver can't work
right and you may develop liver failure, liver cancer, and
liver-related death. NASH is one of the leading causes of cirrhosis.
Both types of NAFLD are becoming more common. Up to 20%
of adults may have either fatty liver or NASH. And more than 6 million children
have one of these conditions, which are most common in Asian and Hispanic
children. Recent evidence indicates that NAFLD increases the risk of heart disease in children who are overweight or
obese.
Causes of Nonalcoholic Fatty Liver Disease
(NAFLD)
The cause of nonalcoholic fatty liver disease is not
clear. Certain factors tend to increase risk, but in some cases, no risk
factors show up. However, NAFLD tends to run in families. It also shows up most
often in people who are middle-aged and overweight or obese. These people often
have high cholesterol ortriglycerides and diabetes orprediabetes (insulin resistance), as well.
Other potential causes of fatty liver disease include:
·
Medications
·
Viral hepatitis
·
Autoimmune or
inherited liver disease
·
Rapid weight loss
·
Malnutrition
Recent studies show that an overgrowth of bacteria in the small intestine and
other changes in the intestine may be associated with nonalcoholic fatty liver
disease. Some researchers now suspect this may play a role in the progression
of NAFLD to NASH.
Acute Fatty Liver of Pregnancy
Though very rare, fat can build up in the liver of a
mother duringpregnancy, putting both mother and fetus at
serious risk. Either may develop liver failure, kidney failure, severe
infection, or hemorrhage. No one fully understands its cause, but hormones may
play a role.
Once a diagnosis is confirmed, the baby is delivered as
quickly as possible. Although the mother may need intensive care for several
days, liver function often returns to normal within a few weeks.
Symptoms
of Fatty Liver Disease
Fatty liver disease is often silent, producing no
symptoms, especially in the beginning. If the disease advances -- which is
usually over a period of years, or even decades -- it can cause vague problems
such as:
·
Fatigue
·
Weight loss or loss
of appetite
·
Weakness
·
Nausea
·
Confusion, impaired
judgment, or trouble concentrating
These symptoms may also be present:
·
Pain in
the center or right upper part of the abdomen
·
An enlarged liver
·
Patchy, dark skin discoloration,
usually on the neck or underarm area
With alcoholic liver disease, symptoms may worsen after
periods of heavy drinking. With NAFLD, the disease process can stop or reverse,
or it may worsen. If cirrhosis develops, the liver loses its ability to
function. This can cause signs and symptoms such as:
·
Fluid retention
·
Muscle wasting
·
Internal bleeding
·
Jaundice (yellowing
of skin and eyes)
·
Liver failure
Diagnosis of Fatty Liver Disease
Often a fatty liver shows up during a routine checkup.
Your doctor might notice that your liver is slightly enlarged or see signs of a
fatty liver on a blood test. Or, your doctor may suspect a problem after taking
a health history or doing a physical exam.
Blood tests. During
routine blood tests, elevations in certain liver enzymes may show up. These
might include alanine aminotransferase (ALT) or aspartate aminotransferase
(AST).
Imaging studies. A fatty liver may also show up on imaging tests, such as
an abdominal ultrasound.
Liver biopsy. The only way to confirm a diagnosis of fatty liver
disease is with a liver biopsy. This is usually done once other causes have
been ruled out. After application of local anesthesia, the doctor inserts a
needle through the skin to remove a tiny piece of liver. This is then examined
under a microscope for signs of fat, inflammation, and damaged liver cells. If
inflammation or damage is not present, the diagnosis is simply a fatty liver.
Treatment of Fatty Liver Disease
There is no specific treatment at this time for fatty
liver disease. However, getting treatment for any underlying disease, such as
diabetes, is essential. And you can take other steps to improve your condition.
If you have alcoholic liver disease and you are a heavy
drinker, quitting drinking is the most important thing you can do. Find the
support you need to be successful. With ALD, continued use of alcohol can lead
to advanced disease, including alcoholic hepatitis or cirrhosis. Even for those
with NAFLD, however, avoiding alcohol may help.
If you are overweight or obese, do what you can to
gradually lose weight-- no more than 1 or 2 pounds a
week. A recent study showed that weight loss of at least 9% over a period of
months can help reverse NASH. Even less weight loss than this can help lessen
buildup of fat in the liver.
Eat a balanced and healthy diet and increase your physical activity.
In addition to limiting calories, avoid diets rich in refined, rapidly digested
carbohydrates. This includes limiting foods such as bread, grits, rice,
potatoes, corn, and concentrated sugar that is found in sports drinks and juice.
Treatment of Fatty Liver Disease
continued...
Avoiding unnecessary medicationscan also help
slow or reverse the disease. Clinical trials are also looking at the
effectiveness of certain antioxidants and newer diabetes medications in
treating fatty liver disease (because of disease's link to oxidative stress and
diabetes). These include:
- Vitamin E
- Selenium
- Betaine
- Metformin
- Rosiglitazone
- Pioglitazone
Note that even vitamins and
minerals can lead to health problems. The best way to get their benefits is
through food sources that contain them.
New findings about the role of
bacteria in the development of fatty liver disease may lead to still other
options for treatment, such as by counteracting unbalanced diets with probiotics.
These are dietary supplements containing healthy live bacteria or yeasts.
If cirrhosis becomes severe, a
liver transplant may be needed. A surgeon removes the damaged liver and
replaces it with a healthy one.
WebMD Medical Reference
Reviewed by William Blahd, MD on July
09, 2014
© 2014 WebMD, LLC. All rights
reserved.
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