Let's Talk About Fatty Livers

By Dr Harold Gunatillake - Health Writer

Fatty liver occurs when fat accumulates in the hepatic cells and tissues. Some amount of fat is normally found in the liver.These Fatty livers get swollen with fat and slow down metabolism. This means that the liver burns fat less efficiently, resulting in weight gain. One could also get fatty livers and not get fat.

Fat infiltration or eating into the liver cells will result in less and less functioning cells being available. Early stages of fatty liver may cause no damage, but excess fat leads to inflammation of the liver and hardening and scarring, referred to as Cirrhosis.

Fatty liver was first described in 1980 by the Mayor Clinic. It is the most abnormal liver condition detected among most people in most countries, including Sri Lanka. It may not be caused by excessive alcohol intake, and hence referred to as Non-Alcoholic Fatty Liver Disease (NAFLD).

There is a type of NAFLD labelled Non-Alcoholic Steato-Hepatitis (NASH) where liver cell damage caused by the fat ends in cirrhosis (hardened liver), and liver failure. NASH can also lead to liver cancer. This type of liver disease can be reversed in the early stages through simple lifestyle changes.

Fatty livers are linked to obesity and with increase in obesity in a population, fatty livers become more prevalent. This condition leads to insulin resistance and type 2 diabetes.

Malnutrition
The high incidence of fatty liver among the rural and less affluent people could be attributed to the high incidence of malnutrition among them. Among the city dwellers obesity, excessive use of toxicity from prescribed medication, alcoholism and diabetes may be the causes of fatty livers.

Influence of non-alcoholic fatty liver disease (NAFLD) in Sri Lanka (ref J. Gastroenterol Hepatol 2013 Jan 28 by Kasturiratne, Weerasinghe, Dassanayake, Rajindrajith, de Silva, Kato, Wickremasinhe and HJ de Silva), diagnosed ultrasonically have increased risk of developing diabetes mellitus. Further they observe that intervention for NAFLD through lifestyle modification may prevent progression of the current diabetes epidemic.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in Sri Lanka and may progress to advanced hepatic fibrosis and cirrhosis, as reported by Rajindralth, Dassanayke, Hweavisnthi, H.J de Silva reported in Hepatol int.Jun 2008.

The cause of non-alcoholic fatty liver disease is not clear. It may run in families, and those who are obese or overweight. These people also suffer from Metabolic X syndrome- a cluster of disorders that increase the risk of diabetes, heart disease and stroke, with high cholesterol or triglycerides, may play an important role in the development of fatty liver disease. Other potential causes are medications, viral hepatitis, Autoimmune or inherited liver disease, rapid weight loss and malnutrition. Recent finding is that overgrowth of unwanted pathogenic germs in the small intestine may be associated with non-alcoholic fatty liver disease.
Alcoholic fatty liver

More than 15 million people in the US abuse or overuse alcohol. Most of them develop fatty livers with complications. It normally occurs with chronic alcohol drinking for long periods. It could also even occur after a short period of heavy drinking.

Other factors that may result in fatty livers among the alcoholics are: Hepatitis C: An overload of iron: Obesity and diet.

Outlook
If the fatty liver condition progresses, it may cause inflammation and a build-up of fibrous tissue resulting in hardening of the liver- cirrhosis. If nothing is done the patient may become overweight, and the quality of life diminishes.

Many people are unaware that they have fatty livers, as there are no symptoms during the early stages or may not have any symptoms even decades. Increased fatigue and generally unwell feeling may be attributed to stress and over work.

Fatty liver is diagnosed with a blood test and liver ultrasound scan. Sometimes your doctor will be able to feel a fatty enlarged liver. Other tests may be done to rule out other diseases of the liver.
The only way to be sure is by doing a non-invasive needle biopsy and removing a sample of liver tissue for analysis.

Preventing and reversing
Lose weight; lower your triglycerides through diet and medication. Abstain from drinking alcohol, control your sugar if you are a diabetic, eat a balanced healthy diet, increase your physical activities and get regular check-up.

A fairly new drug orlistat (Xenical) a medication that blocks the absorption of some fat may reduce the amount of fat in the liver. So, changing lifestyle would be the answer for this reversible disease.

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