Fatty liver or Non-alcoholic fatty liver disease (NAFLD) is a broad term used to describe a number of conditions caused by fat build-up in liver cells. It ranges from:
- Simple steatosis: the accumulation of fat in the liver without damage or inflammation. It can progress to liver inflammation (NASH)
- Non-alcoholic steatohepatitis (NASH): is the state where fat in the liver causes inflammation. This inflammation damages liver cells, causes scarring and over many years may lead to irreversible scarring called cirrhosis.
Fatty liver is a common condition that affects up to 30% of the population. It is the most common cause of chronic liver disease in developed countries. Up to 10% of the population may be affected by the more severe inflammatory form NASH.
Fatty liver is associated with the following:
- being overweight, especially around the abdomen
- high cholesterol or triglycerides
- type 2 diabetes
- high blood pressure
For most patients, the condition remains as uncomplicated steatosis or NASH. In a third of patients with NASH, scarring can continue to progress, ultimately leading to a state of irreversible damage called cirrhosis. Patients with cirrhosis can have life-threatening complications such as liver failure and are at higher risk of liver cancer. Patients with fatty liver also have a higher risk of diabetes, heart disease and bowel polyps.
The suspicion of fatty liver is most commonly raised with abnormal liver blood tests in a patient with risk factors. Usually these blood tests have been performed for unrelated reasons, as fatty liver often does not cause symptoms. A simple scan such as an ultrasound may be able to detect fatty infiltration. If there is any doubt regarding the diagnosis or if there is a need to determine the severity of liver damage, a liver biopsy may be suggested. This is the gold standard for fatty liver diagnosis but is rarely needed these days.
The mainstay of treatment is lifestyle intervention including diet and exercise. Certain foods can assist with fatty liver and there is now evidence that Omega-3 supplementation or the anti-oxidant Vitamin E may also help. Discussion with one of our specialists will help determine the stage of fatty liver you have and what regimen is needed to reduce the risk of the condition progressing.
- Assessment of fatty liver disease stage and differentiation between simple steatosis and NASH
- Fibroscan to assess extent of liver scarring (fibrosis)
- Diet and Lifestyle advice for management of NAFLD
- Use of therapeutics where indicated
- Access to drug and lifestyle trials for new NASH treatments
- Referral for bariatric surgery when appropriate