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  • Alan Frischer, MD, MPH

Fatty Liver

Are you aware that the liver is the second largest organ in our body? When blood leaves our stomach and intestines, it passes through the liver. The liver processes this blood; breaks it down, balances it, creates nutrients, and metabolizes medications into forms that are easier to use. Fatty liver disease occurs when fat builds up in the liver. It is also known as hepatic steatosis, and is a common condition. What should you know about fatty liver disease?


It is normal for the liver to contain fat, but too much leads to inflammation, which can cause damage and create scarring. In severe cases, this scarring can lead to liver failure. Fatty liver in those who drink a lot of alcohol is called alcoholic fatty liver disease (AFLD), and in others, it is called nonalcoholic fatty liver disease (NAFLD).


NAFLD is the most common chronic liver condition here in the United States. About 55% to 75% of obese people likely have some degree of NAFLD. Perhaps 20% of those with AFLD will progress to cirrhosis, and they account for some 50% of cirrhosis deaths worldwide. For those with NAFLD, perhaps 5-12% progress to cirrhosis. Fatty liver disease is the most common reason for liver transplantation.


Both NAFLD and AFLD have four typical stages:

  • Stage 1: Simple fatty liver. There is a buildup of excess fat. Simple fatty liver is generally not harmful if it doesn’t progress. For many, there are no symptoms.

  • Stage 2: Steatohepatitis. In addition to the excess fat, there is inflammation.

  • Stage 3: Fibrosis. Persistent inflammation leads to scarring. However, the liver can still usually function normally.

  • Stage 4: Cirrhosis. Scarring has become widespread, impairing the liver’s ability to function. This is the most severe stage, is potentially life threatening, and is irreversible.


Cirrhosis has a number of really terrible symptoms, including abdominal pain, loss of appetite, weight loss, weakness, nausea, itchy skin, yellow skin and eyes (jaundice), easy bruising or bleeding, dark colored urine, pale stool, fluid accumulation in the abdomen, swelling of the legs, clusters of blood vessels under the skin, breast enlargement, and even confusion. And, of course, it can lead to liver failure. In addition, steatohepatitis and cirrhosis are risk factors for hepatocellular carcinoma, the most common form of liver cancer.


The cause of AFLD is simple: drinking too much alcohol. Alcohol can alter certain metabolic processes in the liver, and when the products combine with fatty acids, there is excess fat accumulation. The Centers for Disease Control and Prevention defines heavy drinking as 15 or more drinks per week for men, and eight or more drinks per week for women.


Causes of NAFLD include obesity, type 2 diabetes, and high cholesterol, as well as pregnancy, certain medications, hepatitis C, and some rare genetic conditions.


The diagnosis of fatty liver disease is usually made when blood tests show elevated liver enzymes, which indicate inflammation. It shows up on ultrasound, CT or MRI. A liver biopsy will indicate how serious it is.


If you are diagnosed with this disease, even if you experience no symptoms or problems with liver function yet, it is critical to take action to stop or reverse it. There are no medications to treat fatty liver disease. However, in most cases, lifestyle changes can manage it and even reverse the damage. The key steps are to stop drinking alcohol, lose weight, change the diet, exercise, and avoid medications or supplements that are hard on the liver.


I encourage you to consider a diagnosis of fatty liver disease as an early warning sign. Use this notice to avoid life-threatening cirrhosis or liver cancer. As always, speak with your doctor, and together make a plan.

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