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Routine blood work may uncover this silent but preventable disease.
One out of every four people in the United States has fatty liver disease, a condition in which excess fat builds up in the liver and causes the liver cells to swell and become damaged. Most people don’t know they have fatty liver disease. “Fatty liver disease can be present for many years before symptoms, such as fatigue, abdominal pain, jaundice (yellowing of the skin and eyes), itching, and swelling, can develop,” says Svetlana Korenfeld, MD, Highland Medical, Rockland Gastroenterology and Liver Disease in West Nyack, NY. “As more liver damage occurs, the disease progresses.”
DIAGNOSIS
Fatty liver is usually first discovered during a routine blood test or screening for another medical condition. Elevated liver enzymes may show up in a blood test, or an ultrasound may show an enlarged liver. Before the diagnosis can be made, other conditions, such as viruses, autoimmune conditions and some genetic conditions, must be excluded. Your doctor will need to check if any of the medications you are taking can be contributing. This condition, nonalcoholic fatty liver disease (NAFLD) or metabolic-associated steatotic liver disease (MASLD), can get worse and cause liver inflammation. When inflammation is present, it is called nonalcoholic steatohepatitis (NASH) or metabolic dysfunction-associated steatohepatitis (MASH). Newer imaging techniques can be used to determine the degree of liver damage. These include ultrasound or MRI elastography, which measure the stiffness of the liver. If the diagnosis is still inconclusive, a liver biopsy may need to be performed.
TREATMENT OPTIONS
The first line of treatment for fatty liver is weight loss, which is usually done through exercise and healthy eating. It is recommended to reduce 7 to 10% of body weight over one year to reduce fat in the liver and decrease inflammation. Rapid weight loss through fasting can make liver inflammation worse. It’s best to eat a diet rich in fruits, vegetables and whole grains and limit the intake of animal products. Limiting sugar and salt intake as well as avoiding alcohol can also help. Moderate to intense exercise for 30 minutes a day is recommended. Another vital part of treatment is managing diabetes and high cholesterol. If left untreated, fatty liver can lead to serious complications, such as liver fibrosis and cirrhosis. Fatty liver causes inflammation, which leads to scarring called fibrosis. When scar tissue takes over most of the liver, it leads to cirrhosis, which cannot be reversed. If cirrhosis is not treated, it can cause the liver to not work properly or not work at all. Patients with liver failure may eventually need a liver transplant. For people with more advanced liver disease due to MASH, a medication called resmetirom (Rezdiffra) was recently approved for stage 2 or 3 fibrosis by the Food and Drug Administration.
WHO IS AT RISK?
Fatty liver tends to develop in people who are overweight or obese, or have diabetes, high cholesterol, high triglycerides, obstructive sleep apnea or high blood pressure. Most affected people are between the ages of 40 and 60, although younger people can be affected. The condition is more common in women, especially after menopause.
PREVENTION
Fatty liver disease can be prevented by maintaining a healthy weight through exercising regularly and eating a healthy diet. A diet rich in fruits, vegetables and healthy fats found in fish, nuts and fruits is a good start. Avoiding foods high in fructose (soda, sports drinks), processed carbohydrates (white bread, rice, pasta), and fatty foods (red meat, deli meats, full-fat dairy) is helpful as well. Being physically active (walking, jogging, swimming, cycling) can also help prevent fatty liver. It is also important to manage stress, get 7 to 8 hours of sleep a night and limit alcohol intake. “Before scarring occurs in the liver from inflammation, fatty liver can be completely reversed,” says Dr. Korenfeld. “Even when scarring occurs, healthy lifestyle choices can slow or even stop progression.” Patients diagnosed with fatty liver should follow up with their doctor to check liver enzymes every six to 12 months. Patients who are overweight, have high cholesterol or have diabetes should follow closely with their doctors to manage these conditions. Scientists don’t know why some people with fatty liver develop inflammation and scarring and some don’t. Genetics, ethnicity, sex and other medical conditions might play a role. This disease usually takes a long time to progress; therefore, there is ample time to prevent or reverse it by following healthy lifestyle choices.
Highland Medical, Rockland Gastroenterology and Liver Disease, is located at 2 Medical Park Drive, Suite 14, West Nyack, NY. Call 845-362-3300 to schedule an appointment with a board-certified gastroenterologist.
