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Fatty Liver Disease

Dr. Naga Chalasani, Liver Specialist, Indiana University Medical Center, has provided a concise article relating to Fatty Liver Disease, how the health of the general public is linked to the diagnosis of this disease, and treatment options.

Nonalcoholic fatty liver disease (NAFLD) is a common liver problem in the United States. It is a condition where there are excess fat deposits in the liver. It is normal to have fat in less than 5% of the liver cells but in people with fatty liver there are far more deposits of fat in the liver cells. It is seen both in children and adults. Recently there has been a rapid rise in the cases of fatty liver that are being diagnosed. This is because of increasing frequency of obesity, diabetes and cholesterol problems. It is a condition seen in people without significant alcohol consumption.

Patients with NAFLD may not have any symptoms but they frequently have higher liver enzymes and an abnormal looking liver as seen in an ultrasound exam or CT scan. This condition may be uncovered when your doctor orders routine blood tests to check your cholesterol levels or an ultrasound or CT scan to investigate fatty liver.

There are two types of NAFLD. One type is simple fatty liver where liver has excess fat but there is no swelling or fibrosis (scarring). This is thought to be benign and rarely causes serious liver problems such as cirrhosis. A more serious type of NAFLD is called NASH (Nonalcoholic steatohepatitis). In this type of fatty liver, there are excess fat deposits in the liver cells but more importantly there is also significant swelling and fibrosis (scarring). NASH is a progressive type of liver condition and it is estimated that 25% of patients with NASH may end up with cirrhosis within 10 years after diagnosis if left untreated. In fact, NASH is one of the most common reasons for cirrhosis in the United States. Distinguishing simple fatty liver from NASH requires a liver biopsy. Research is ongoing to develop noninvasive alternatives to liver biopsy but at this time none of them are accurate enough to replace liver biopsy.

The symptoms of NASH include enlarged painful liver, tiredness, and cirrhosis. It was recently recognized that people with NASH may have increased risk to develop type 2 diabetes and also may have increased risk of heart attacks. More importantly NASH patients once they reach the stage of cirrhosis are certainly at risk for liver failure and very rarely liver cancer.

If your doctor has diagnosed you with NAFLD, it is important to discuss with your doctor whether you should undergo a liver biopsy to identify whether you have NASH or simple fatty liver. If you are diagnosed with NASH, it requires your full attention.

Regardless of the type of NAFLD you have, losing weight is an important way to improve your fatty liver. Recent studies have shown that losing 10% body weight will lead to significant improvement in fatty liver but it is important to achieve this weight loss through exercise and balanced diet. Rapid weight loss through herbal remedies or fad diets (e.g., Atkins) is typically not recommended. Once weight is lost, it is important to avoid gaining it back because weight cycling may not be helpful to NAFLD.

Patients with NAFLD often have co-existing diabetes, obesity, hypertension, cholesterol, and thyroid problems. It is very important to have all these conditions managed optimally as their good control will benefit your liver condition and your overall health. Although it was previously thought that cholesterol medicines may not be safe in patients with NAFLD or elevated liver tests, it is now very clear that statins are very safe in patients with fatty liver and are quite liver-friendly. It is important to minimize alcohol consumption if you are diagnosed with NAFLD (i.e. no more than 2-3 drinks each month). Contrary to popular belief, taking acetaminophen (Tylenol) is fine as long as its daily dose does not exceed 2-3 grams (4-6 tablets of extra-strength Tylenol).

There are no proven medications to treat NASH at this time. Diabetes medications such as Actos (pioglitazone) and Avandia (rosiglitazone) have shown some promise but more research is needed to establish their safety before they are routinely used in clinical practice. Although used by some patients, mild thistle has not been tested properly in humans and cannot be recommended for routine clinical use.

There is significant ongoing research in the field of nonalcoholic fatty liver disease. IU investigators are part of the NIH funded NASH Clinical Research Network (NASH CRN) and have several ongoing research studies that may be benefit to you. Interested individuals may contact IU fatty liver disease research team at 317-274-3514.

Page updated: December 10th, 2007