Fatty liver disease is characterized by the buildup of excess fat in your liver. Normally, it does not cause any symptoms or problems. However, in a small number of patients, it can cause complications such as inflammation of the liver, which can progress to a serious condition called cirrhosis, liver failure, and liver cancer.

Diagnosing it early and treating it promptly helps to minimize the onset of these complications. Diagnosis of fatty liver is done with help of blood tests and imaging studies. Treatment and management mainly consist of a disciplined lifestyle and a healthy liver diet.

Diagnosis of fatty liver

Because most patients with fatty liver have no symptoms, testing is usually recommended for people who are overweight or obese, harbor risk factors, or indulge in alcohol abuse.

Testing for fatty liver in people without any preexisting comorbidities, signs of liver inflammation or alcohol abuse is not recommended.

Since hepatic steatosis causes no symptoms in most cases, it is frequently detected when tests are done for other reasons.

Four major types of tests are used to diagnose fatty liver:

  1. Blood tests
  2. Imaging tests such as ultrasound, computed tomographic (CT) scan, and magnetic resonance imaging (MRI)
  3. Newer tests quantify the amount of fat in the liver, such as transient elastography, an ultrasound-based test that measures how stiff the liver is.
  4. Liver biopsy is recommended for diagnosing more advanced liver diseases, such as NASH and liver fibrosis.

Blood tests to look for fatty liver

The following blood tests are done to confirm the presence of fatty liver and to rule out existing risk factors.

  • Complete blood count
  • WBC count. Elevated WBC counts, even within the normal range, have been associated with Non-Alcoholic Fatty Liver Disease (NAFLD).
  • RBC count. An increased RBC count was independently associated with a high risk of NAFLD incidence and progression.
  • Hemoglobin. Hemoglobin is significantly higher in people with NAFLD, as compared to healthy patients.
  • Liver function tests. Alanine aminotransferase (ALT) is a specific marker for liver inflammation and is typically elevated in individuals with a fatty liver.
  • Fasting blood sugar is done to rule out diabetes, which is a risk factor for fatty liver.
  • HbA1C test will help show how stable your blood sugar levels are over a period.
  • A lipid profile test measures your blood fats such as cholesterol and triglycerides. High levels of these lipids are another risk factor for fatty liver disease.

Ultrasound and MRI imaging procedures

  • Abdominal ultrasound is often the first test recommended when liver disease is suspected.
  • CT scan or MRI of the abdomen may also be recommended for better viewing of the liver parenchyma.
  • Transient elastography is an improved form of ultrasound that measures your liver stiffness with high accuracy on an elastogram. The presence of liver stiffness indicates liver fibrosis.
  • Magnetic resonance elastography is a new imaging technology that creates an elastogram (a visual map) showing liver stiffness and thereby fibrosis in the liver.

Liver tissue biopsy

If other tests are inconclusive, your doctor may recommend a liver biopsy. It involves a procedure to remove a sample of tissue from your liver, which is examined in a laboratory to look for signs of inflammation and scarring.

Treatment

There is no medication approved for removing the excess fat from your liver. Management of fatty liver is mostly about losing weight, controlling the comorbidities, shifting to a healthy lifestyle, and adopting the right diet that has been formulated to reverse or prevent fatty liver. 

Losing weight for fatty liver disease

For people who are overweight or have obesity, losing weight is the most important thing you can do to control or reverse non-alcoholic fatty liver disease (NAFLD). Abstinence from alcohol is the single best thing you can do to control or reverse alcoholic fatty liver.

You can achieve weight loss effectively with the right diet and exercise.

Studies show that losing 10 percent of your body weight can improve your liver function test reports, which results in a reduction in liver inflammation and excess fat in the liver.

Weight loss plays a major role in preventing fatty liver complications of inflammation and fibrosis from setting in.

Weight loss has to be slow and steady. Research suggests that rapid weight loss can actually worsen fatty liver disease.

Controlling comorbidities

Healthy lifestyle

If you have alcoholic or nonalcoholic fatty liver, abstain from alcohol.

Choose a healthy diet. Eat a healthy diet that has fruits, vegetables, and whole grains. Keep a check on the calories to stay at a healthy weight. Your diet should supply your body with fiber, protein, and healthy fats.

Exercise and stay physically more active.

Regular physical exercise is the key to a healthy liver. It is a proven therapeutic strategy to improve fatty liver disease. It reduces the strain on the liver and also helps to prevent you becoming overweight or obese.

Aerobic exercise can get rid of excess fat in your liver. A good workout may also lower inflammation. Besides aerobic exercise, resistance or strength training exercises, like weight lifting, can also improve fatty liver disease.

How much should you exercise? You should aim for a total of 150 minutes of exercise per week. Brisk walking and swimming are some exercises that will help improve liver health.

Exercise not only increases the rate of fatty acid oxidation but also decreases its synthesis and prevents hepatocellular damage.

Adopt the fatty liver diet

Incorporate the following foods into your fatty liver diet.

  • Fish and seafood
  • Fruits
  • Whole grains
  • Nuts
  • Olive oil
  • Vegetables
  • Avocados
  • Legumes

And, avoid the following foods if you have fatty liver

  • Alcohol
  • Added sugar
  • Fried foods.
  • Added salt
  • White bread, rice, and pasta
  • Red meat

Take care of your liver

Avoid things that will harm your liver. For instance, certain meds can be liver toxic. Avoid them and ask your doctor for alternatives. Half the cases of liver failure in the United States are due to medications.

Similarly, certain herbal compounds too can cause liver damage. Avoid using them

Prognosis

Will fatty liver disease kill you? Fatty liver disease doesn’t cause any major problems. It will not kill you. You may live the rest of your life without any symptoms and problems.

In the early stages (grade 1 to 3), early medical intervention and disciplined implementation can reverse the process of the disease. However, a small percentage of fatty liver patients may develop complications. Things can get complicated when the liver may get inflamed and turn to steatohepatitis (NASH), which may progress to cirrhosis. This is a serious complication because untreated cirrhosis of the liver eventually leads to liver failure or liver cancer.

Patients who have alcoholic fatty liver disease and who continue to drink too much alcohol are at a risk of 8–30% of developing cirrhosis after 10 years.

In the case of nonalcoholic fatty liver disease, some individuals can develop nonalcoholic steatohepatitis (NASH). This is a more progressed form of liver condition marked by inflammation of the liver tissue. This can progress to scarring of the liver tissue (cirrhosis) and liver failure. Between 5% and 12% of people with NASH will progress to cirrhosis.

It used to be believed that it took decades for progression from early stage NAFLD to cirrhosis. However, recent studies indicate that in some people, this complication can progress rapidly and develop within 2 years.

According to Mayo Clinic, 5% and 12% of people with NASH will develop cirrhosis.

Prevention

A healthy lifestyle, proper diet and regular exercise are the key to prevent fatty liver and its complications.

Some effective preventive tips include:

  • Limit alcohol intake or better still abstain from alcohol
  • Maintain the right weight
  • Follow the fatty liver diet. Stay low on saturated fats, trans fats, and refined carbohydrates
  • Control your comorbidities – diabetics should control their blood sugar, hypertensives should keep their blood pressure under control,  and those with an unhealthy lipid profile should keep their triglyceride and cholesterol levels in check.
  • Aim for at least 30 minutes of exercise five days a week.

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