Fatty liver disease

NAFLD is primarily caused by fat accumulation in the liver, and the following risk factors contribute to its development:

Diet and Eating Habits

Frequent consumption of fast food, large portions containing high levels of saturated fats and refined carbohydrates can increase the risk of developing NAFLD. Eating late at night, skipping breakfast, and consuming food too quickly can also contribute to insulin resistance, which in turn promotes the disease.

Overweight or Obesity

Obesity is a major risk factor for NAFLD. Studies show that up to 75% of overweight individuals and 90% of obese individuals are affected by the condition.

High BMI

A high Body Mass Index (BMI) is linked to an increased risk of NAFLD. BMI is a measure of body fat based on height and weight.

Age

The risk of developing NAFLD increases with age, as older individuals are more prone to organ dysfunction. Many individuals with advanced NAFLD develop cirrhosis by their 70s or older.

Family History

Research indicates that fatty liver conditions and the liver fat content can be inherited, meaning the disease may run in families.

Type 2 Diabetes

Type 2 diabetes significantly raises the risk of NAFLD, and the two conditions often coexist.

High Cholesterol

Dyslipidemia (an imbalance in blood lipids) including high triglycerides, elevated LDL (bad cholesterol), or low HDL (good cholesterol) levels, can increase the likelihood of developing NAFLD.

Metabolic Syndrome

Metabolic syndrome involves a combination of risk factors that make a person more likely to develop type 2 diabetes and cardiovascular diseases. The diagnostic criteria for metabolic syndrome include at least three of the following:

• Triglycerides ≥150 mg/dL
• Low HDL cholesterol (less than 40 mg/dL in men, less than 50 mg/dL in women)
• High fasting glucose (≥100 mg/dL)
• Increased waist circumference
• High blood pressure (≥130/85 mmHg)
• The rise in metabolic syndrome is closely tied to the increasing incidence of NAFLD.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS are at a higher risk of developing NAFLD due to the increased risk of insulin resistance, a key factor in liver damage.

Obstructive Sleep Apnea

Obstructive sleep apnea may increase the risk of NAFLD by causing insulin resistance, inflammation, and dyslipidemia.

Hepatitis Infections

Chronic hepatitis B (HBV) and hepatitis C (HCV) are common causes of liver disease globally, and they are also risk factors for the development of NAFLD.

Genetic Conditions

Conditions such as Wolman’s disease and cholesterol ester storage disease (CESD), which result from mutations in the LIPA gene, can lead to chronic liver diseases and fibrosis that may progress to cirrhosis.

Certain Medications

Some medications, such as corticosteroids, antidepressants, and antipsychotics, may cause fatty liver as a side effect.

Smoking

Smoking increases the risk of insulin resistance and metabolic syndrome, both of which are significant risk factors for fatty liver disease.

NAFLD can be difficult to diagnose because early stages often show no symptoms. A combination of laboratory tests and imaging techniques is required to confirm a diagnosis. The diagnostic process includes:

Medical History

Your doctor will assess risk factors and confirm that there is no excessive alcohol consumption.

Physical Examination

During the physical examination, your doctor will check for signs of liver dysfunction such as jaundice (yellowing of the skin), red palms, gynecomastia (enlarged breast tissue in men), and abdominal swelling. They may press on the abdomen to feel for an enlarged liver.

Blood Tests

• Liver Function Tests (LFT): This test measures enzyme and protein levels produced by the liver and can reveal liver dysfunction.
• Complete Blood Count (CBC): This test helps detect anemia or infections, which may indicate liver problems.
• Fasting Serum Glucose: Elevated levels can be a marker for more severe NAFLD.
• Hepatitis Antibody Test: This test helps rule out hepatitis B and C infections, which can cause liver damage.
• Other Blood Tests: Antibodies may be screened for autoimmune liver diseases.

Imaging Tests

To assess liver size, texture, and inflammation, the following imaging tests may be recommended:

• Abdominal Ultrasound: This non-invasive procedure detects fatty liver by showing a brighter liver on the image.
• Abdominal CT Scan: This scan uses x-rays to generate detailed images, detecting fatty liver and other liver conditions.
• MRI (Magnetic Resonance Imaging): Uses magnets and radio waves to create detailed liver images. A contrast dye is injected to help visualize liver abnormalities.
• MRCP (Magnetic Resonance Cholangiopancreatography): A specific MRI to evaluate the liver and gallbladder.
• MRE (Magnetic Resonance Elastography): Assesses liver stiffness, inflammation, and scarring.
• Transient Elastography (FibroScan): This test measures liver fibrosis, or scarring, and helps determine the degree of liver damage.

Liver Biopsy

A liver biopsy involves taking a small tissue sample from the liver for microscopic examination. This is considered highly accurate for diagnosing NAFLD, especially in patients with unexplained elevated liver enzymes.

Maintaining a healthy lifestyle is key to preventing fatty liver disease and its potential complications. Here are some important tips to keep the liver, a remarkable organ that can regenerate itself, in optimal health:

Eat Well

A balanced and nutritious diet is crucial for preventing fatty liver. To achieve this, include:

• Green vegetables, fresh seasonal fruits, whole grains, lean protein sources, nuts, seeds, and low-fat dairy.
• Healthy fats like polyunsaturated omega-3 fats, while avoiding saturated and trans fats.
• Increased dietary fiber intake.
• Avoid fast food, canned items, and packaged foods.
• Limit sugar consumption.

Maintain a Healthy Weight

Losing weight in moderation can improve insulin sensitivity. Aim for a weight loss of about 10% of your body weight over six months by restricting energy intake to 25-30 kcal/kg/day, which can prevent and help control fatty liver.

Exercise Regularly

Consistent physical activity is essential in preventing fatty liver. Set achievable goals like walking for 15 minutes a day or engaging in 15 minutes of exercise. Small, attainable objectives can help make exercise a daily habit and keep you motivated.

Protect Against Hepatitis

Avoiding hepatitis infections, especially hepatitis B and C, can reduce the risk of liver cirrhosis. To protect yourself, follow these precautions:

• Practice safe sex.
• Avoid getting tattoos or piercings in unsanitary conditions.
• Get vaccinated against hepatitis B and C.
• Never share needles.

Control Diabetes and Cholesterol

Both diabetes and high cholesterol are significant contributors to NAFLD. It is important to keep these conditions under control through a healthy diet, regular exercise, monitoring your levels, and having regular check-ups with your doctor.

Specialists to Consult

A general physician can help assess liver abnormalities and refer you to specialists such as:

• Gastroenterologist: A doctor who specializes in the treatment of disorders affecting the digestive system, including the liver.
• Hepatologist: A medical expert focused on liver diseases and disorders affecting the biliary tract, gallbladder, and pancreas.

The first step in treating fatty liver disease is lifestyle modification, which includes dietary changes and an exercise plan.

Dietary Changes

A healthy eating plan is vital for weight loss without malnutrition. Some helpful guidelines include:

• Avoid fast food, canned, and processed foods.
• Limit sugar consumption.
• Keep track of calorie intake. Women should aim for 1000–1200 calories per day, and men should target 1200–1600 calories per day.
• Aim for a weight loss of 0.5–1.0 kg per week, with gradual, sustained weight loss over 6–12 months.
• It’s important to balance macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins, minerals, supplements).

Exercise Regimen

Engaging in 120 minutes of aerobic exercise, such as running or swimming, each week helps improve insulin sensitivity and reduces liver fat.

Resistance training can also improve NAFLD, particularly for those with poor cardiorespiratory fitness who cannot perform intense aerobic exercises.

A study has shown that high-intensity interval training (HIIT) can reduce liver fat.

An exercise plan should be personalized based on:

• The severity of liver dysfunction caused by NAFLD
• BMI
• Fitness levels
• Other components of metabolic syndrome and co-existing medical conditions

Weight Loss Medications

While dietary changes and exercise are crucial for weight management, medications such as Orlistat can aid in moderate weight loss by reducing fat absorption.

Bariatric Surgery

In cases where lifestyle changes fail to result in weight loss, bariatric surgery may be an option for severely obese individuals. This surgery improves insulin sensitivity in the liver, muscles, and fat, as well as overall metabolic health.

Dietary Supplements

Certain vitamins and supplements can help manage fatty liver disease:

• Vitamin E: It reduces triglycerides and oxidative stress, slowing fatty liver progression. Natural sources include wheat germ oil, sunflower seeds, almonds, peanuts, spinach, pumpkin, and red bell pepper.
• Vitamin C: This vitamin helps protect the liver from oxidative damage and prevents fat accumulation.
• Vitamin D: A deficiency in vitamin D can lead to insulin resistance and metabolic syndrome, contributing to NAFLD. Studies show that 70% of NAFLD patients are deficient in vitamin D, so ensuring adequate levels is important for managing fatty liver disease.

Medications

Although there are no specific drugs for fatty liver disease, medications may be prescribed to manage underlying conditions such as:

• High Triglycerides and Cholesterol: Statins like Atorvastatin and Lovastatin may be used.
• Viral Hepatitis: For chronic fatty liver disease, antiviral drugs such as Lamivudine, Entecavir, and Tenofovir Disoproxil Fumarate may be prescribed.
• Diabetes and Insulin Resistance: Medications like Metformin, Rosiglitazone, and Pioglitazone are commonly used for diabetes management.

If left untreated, fatty liver disease can progress to more severe conditions, including liver inflammation, fibrosis, and cirrhosis, which can ultimately become life-threatening. Some potential complications include:

Bleeding

As liver function deteriorates due to inflammation, fibrosis, and cirrhosis, its ability to produce clotting factors decreases, leading to an increased risk of severe bleeding.

Jaundice

Fatty liver disease can impair the liver’s ability to process and remove excess bilirubin, a waste product, resulting in jaundice (yellowing of the skin and eyes).

Infections

The progression of fatty liver disease weakens the body’s immune response, making it more susceptible to recurrent bacterial infections.

Chronic Viral Hepatitis

Fatty liver disease accelerates the progression to fibrosis and cirrhosis, especially if accompanied by a liver infection, such as viral hepatitis.

Osteoporosis

Patients with fatty liver disease are at higher risk of developing osteoporosis, with research showing that those with NAFLD are 1.35 times more likely to experience bone loss compared to individuals without the condition.

Diabetes

Fatty liver disease, especially when it progresses to cirrhosis, can worsen existing diabetes and increase the risk of complications.

Liver Failure

Long-term fatty liver disease significantly raises the risk of liver failure, where the liver can no longer perform its essential functions.

Liver Cancer

The scarring and cirrhosis caused by fatty liver disease heighten the risk of liver cancer, particularly hepatocellular carcinoma (HCC).

Acute Fatty Liver of Pregnancy (AFLP)

A rare but severe complication that arises in the third trimester of pregnancy, AFLP can be managed with timely delivery and supportive care, with recovery typically occurring within weeks post-birth.

Several complementary therapies may assist in managing the symptoms of NAFLD:

Traditional Chinese Medicine (TCM)

TCM has been used for centuries in Asia to treat fatty liver disease, focusing on protecting the liver, enhancing insulin sensitivity, and boosting immunity.

Acupuncture

This TCM practice involves inserting fine needles into specific points on the body to promote healing. Studies have shown that acupuncture can help treat NAFLD by reducing inflammation and improving fat metabolism in liver cells.

Yoga

Certain yoga poses can stimulate and strengthen the liver, aiding in the release of stored fat and enhancing liver function. Some helpful poses include:

• Garland Pose (Malasana)
• Cobra Pose (Bhujangasana)
• Downward Facing Dog Pose (Adho Mukha Svanasana)
• Boat Pose (Naukasana)
• Plough Pose (Halasana)
• Child Pose (Balasana)
• Frog Pose (Mandukasana)
• Bow Pose (Dhanurasana)
• Alternate Nostril Breathing (Anulom Vilom Pranayama)
• Skull Shining Breath (Kapalbhati Pranayama)

Several home remedies can complement lifestyle changes and other treatments for managing fatty liver disease:

1. Coffee: Research has shown that coffee consumption can reduce the risk of fatty liver disease, including lowering the risk of fibrosis.
2. Turmeric: Known for its antiseptic, antibacterial, antifungal, and antioxidant properties, turmeric can be beneficial in treating liver conditions. Mixing a pinch of turmeric with hot milk and honey and drinking it daily can help.
3. Apple Cider Vinegar (ACV): ACV supports fat metabolism and helps detoxify the liver.
4. Quick Tip: Always drink ACV with a straw to prevent enamel erosion.
5. Green Tea: Rich in antioxidants, green tea helps reduce oxidative stress, which can lead to liver fibrosis and cirrhosis. It also offers protection against liver disease and has antiviral properties that help fight viral hepatitis.
6. Milk Thistle: Studies suggest that milk thistle is a potent liver cleanser and aids in the regeneration of liver cells. It helps reduce liver damage and eliminates toxins processed by the liver.

In advanced stages of fatty liver disease, where liver function is severely impaired, a liver transplant may be necessary. This procedure involves replacing the diseased liver with a healthy one from a deceased donor or a portion from a living donor. Potential transplant candidates undergo comprehensive testing to ensure they are in suitable health to benefit from the surgery.