Beware of the fatty liver disease

Losing are overweight or obese, losing weight can reduce the amount of fat in your liver.

Image used for representational purpose only. (Express illustrations)

HYDERABAD: Nonalcoholic fatty liver disease (NAFLD) is a medical condition that is characterised by the buildup of fat (called fatty infiltration) in the liver. It is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. NAFLD is known as a silent disease and over many years may go on to cause nonalcoholic steatohepatitis (NASH).

“There are basically two types of NAFLD — nonalcoholic fatty liver (NAFL), a generally benign condition in which there is fatty infiltration but no inflammation, and nonalcoholic steatohepatitis (NASH), in which there is fatty infiltration along with liver inflammation,” says Dr Wahid Akbar (DrNB/ESEGH Gastroenterology), Ujala Cygnus Group of Hospitals.

Nonalcoholic fatty liver
Nonalcoholic fatty liver (NAFL) is a generally benign condition that has become increasingly common worldwide as weight gain and obesity have become more common. It is now the most common cause of liver disorders worldwide.

In NAFL, the liver functions normally and there are no symptoms. NAFL is often found when a person has imaging tests of the abdomen for other reasons (such as an ultrasound being done to look for gallstones). Losing are overweight or obese, losing weight can reduce the amount of fat in your liver.

Nonalcoholic steatohepatitis
Nonalcoholic steatohepatitis (NASH) is a condition that causes inflammation and accumulation of fat and scar tissue in the liver. Although a similar condition can occur in people who abuse alcohol, NASH occurs in those who drink little to no alcohol. The exact cause of NASH is unknown. However, it is seen more frequently in people with certain medical conditions such as diabetes, obesity, and insulin resistance.

Conditions associated with nonalcoholic steatohepatitis
Although the cause of NASH is unknown, it is most frequently seen in people with one or more of the following conditions:

• Obesity
• Diabetes
• Hyperlipidemia
• Insulin resistance
• Certain drugs

Symptoms
Most people with NASH have no symptoms. Rarely, NASH is found (after testing) in people with fatigue, a general feeling of being unwell, and a vague discomfort in their upper right abdomen, although it is not clear if these symptoms are related to NASH.

Diagnosis
NASH is most often discovered following routine blood tests. Additional tests help confirm the presence of NASH and rule out other types of liver disease. Imaging tests (such as ultrasound, CT scan, or MRI) may reveal fat accumulation in the liver but cannot differentiate NASH from other causes of liver disease that have a similar appearance. A liver biopsy may be required to confirm NASH if other causes of liver disease cannot be excluded. Fibroscan is a noninvasive test that uses ultrasound to determine how “stiff” the liver is. Where available, a fibroscan is an alternative to liver biopsy for detecting liver scarring.

Treatment

• There is no cure for NASH. Treatment aims to control the conditions that are associated with NASH such as obesity, diabetes, and hyperlipidemia. Several experimental treatments are being studied with drugs that treat insulin resistance.
• Weight loss: Losing at least 3% to 5% of your body weight can reduce fat in the liver. You may need to lose up to 7% to 10% of your body weight to reduce liver inflammation and fibrosis. Physical activity alone, even without weight loss, is also beneficial. Doctors recommend gradually losing weight to improve NAFLD.
• Treatment of insulin resistance: Several drugs are available for people with insulin resistance, and they are being studied in patients with NASH. Their role is not yet proven.
• Vitamin E: For people with severe forms of NASH who do not also have diabetes or heart disease, healthcare providers sometimes recommend supplements of vitamin E.
•  Avoid alcohol: People with NASH should avoid drinking alcohol because it can worsen liver disease.

Prognosis
NASH is typically a chronic, life-long condition. It is difficult to predict the progression of NASH in an individual. In some people, NASH gets worse over time. The disease can remain asymptomatic for decades. The most serious complication of NASH is cirrhosis, which is when the liver becomes severely scarred. Patients with NASH often have metabolic syndrome (insulin resistance, obesity, and hyperlipidemia). The metabolic syndrome puts you at increased risk for heart disease.

This makes it necessary to undergo screening to arrest the progression into the late stages of liver scarring and liver cancer. Once a significant liver scarring process or liver cirrhosis sets in, reversibility cannot be guaranteed. However, the good news is many people with NASH will not develop serious liver problems. The treatment for NASH (particularly weight loss) also helps treat other problems that are part of the metabolic syndrome.