World Liver Day 2024

 

Understanding and Managing Fatty Liver Disease by
 Dr. Golamari Srinivasa Reddy

Hyderabad 18-04-2024:

What is NAFLD(Non-alcoholic Fatty Liver Disease)?NAFLD is the most common problem seen in daily practice. Butawareness about the disease is not known to many people. Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease worldwide, and its clinical and economic burden will continue to grow with parallel increases in rates of obesity, diabetes, and the metabolic syndrome. Recent studies also suggest that these patients are at elevated risk for cardiovascular, malignancy, and liver-related morbidity and mortality, although their risk for progression, decompensation, and hepatocellular carcinoma, spectrum of liver diseases encompasses the entire spectrum of NAFLD in individuals without significant alcohol consumption, ranging from fatty liver (steatosis) to NASH (Steatohepatitis) to cirrhosis. Steatosis is a common condition caused by having too much fat build up in your liver. A healthy liver contains a small amount of fat. It becomes a problem when fat reaches >5% of your liver’s weight.NASH means fat +inflamed liver which leads to fibrosis and cirrhosis.NAFLD is generally silent and potentially reversible. NASH can progress to advanced fibrosis and cirrhosis. NAFLD is hepatic manifestation of Metabolic Syndrome(MS).It is more common in obesity, but one more entity called as Lean NASH which is seen in patients with BMI <25 kg/m, more common among Asians with genetic morphisms

What is its prevalence?In India, the prevalence is about 35%. It increases upto 88% if people have diabetes millitus. 90% of NAFLD patients have at least one component of Metabolic Syndrome. Nearly 30% of NAFLD patients have all components of Metabolic Syndrome, 7-20% in lean people.

What are the key regulators for fatty liver? Insulin resistance with central obesity is the driving event.Lipotoxicity(High cholesterol) and gut dysbiosis(intestine bacteria),high caloric diet, physical inactivity, relative calorie excess, all lead to fatty liver disease.Inter organ cross talk results in progressive and persistent inflammation leading to fibrosis, visceral adiposity and genetic polymorphisms.

What causes/who gets fatty liver disease? Fatty liver has strong associations with obesity/overweight, T2DM,high blood pressure Dyslipidemia (high cholesterol), polycystic ovary syndrome,hypothyroidoism.

What is the effect of NAFLD on the population? NAFL, over period of six years follow up leads to 11% risk of fibrosis, cirrhosis and HCC,7% risk of liver related and all cause mortality. In one study, 3500 patients over 19-years of follow-up, 1039 people died, NAFLD with all MS components was associated with overall, cardiac and liver-mortality, lower survival.

 

 

What are the symptoms of fatty liver? People with fatty liver disease often have no symptoms until the disease progresses to cirrhosis of the liver. Symptoms could be like feeling of fullness in the upper right side of the abdomen, nausea, loss of appetite.

How is fatty liver disease diagnosed? Because fatty liver disease often has no symptoms, your physician may be the first one to spot it. Higher levels of liver enzymes that turn up on a blood test for other conditions may raise a red flag. Elevated liver enzymes are a sign your liver is injured. To diagnosis, ultrasound of abdomen is done to get a picture of the liver to see grade of the liver. Once fatty liver is diagnosed in ultrasound one should meet a hepatologist to get a fibro scan done to find out the amount of fat and scar tissue present in the liver. Fibro scan gives us fat fraction and fibrosis in liver. If fat fraction or fibrosis is more then liver biopsy needs to be done to see the extent of the disease.

How is fatty liver disease treated? The medication specifically for fatty liver disease will depend on the severity of liver disease. Hepatologists focus on helping you manage factors that contribute to the condition. Treatment includes - avoiding alcohol, losing weight, taking medications to manage diabetes, fat in the blood. Antioxidants like vitamin E, some newer drugs will help stop progression of the disease.

How can fatty liver disease be prevented? The best way to avoid fatty liver disease is to do the things that maintain overall health- stay at a healthy weight. If you are overweight/obesity, lose weight gradually, exercise regularly, limit your alcohol consumption, take medications as prescribed, and do regular health check-ups with

your hepatologist.