Fatty liver - Hepatic Steatosis

Fatty Liver (Hepatic Steatosis)

Fatty liver

Fatty liver, or hepatic steatosis, is a term that describes the buildup of fat in the liver. It’s normal to have small amounts of fat in your liver, but too much can become a health problem.

The liver is the second largest organ in the body. It’s responsible for a wide variety of functions, including processing everything we eat and drink, and filtering harmful substances from the blood. Too much fat in the liver can lead to long-term liver damage. 

Early stage fatty liver is diagnosed when the proportion of liver cells that contain fat is more than 5 percent. This is often diagnosed by looking at small samples taken from the liver under the microscope. Ultrasounds, CT scans, and MRI scans can also help evaluate the fat content of the liver.

The liver commonly repairs itself by rebuilding new liver cells when the old ones are damaged. When there’s repeated damage to the liver, permanent scarring takes place. This condition is called cirrhosis. In mild forms, fatty liver can be a reversible condition that may improve with lifestyle modifications such as diet changes, weight loss, and increased physical activity. In many cases, fatty liver has no symptoms.

Unfortunately, fatty liver is becoming a more common condition, currently affecting around 20 to 30 percent of Americans. Most cases of fatty liver that are associated with inflammation are detected in people between ages 40 and 60, according to the American Liver Foundation.

Fatty liver becomes harmful to the liver when it progresses. Liver inflammation (steatohepatitis) can lead to liver scarring, liver cancer, and end-stage liver disease.

What are the symptoms of fatty liver?

Fatty liver typically has no associated symptoms. However, research has shown that about 20 percent of people with fatty liver inflammation progress to worse conditions. If this occurs you may experience fatigue or abdominal discomfort. Your liver may become slightly enlarged, which your doctor may be able to detect during a physical exam.

It’s believed that the excess fat in the liver, along with certain medical conditions, increases inflammation. If your liver becomes inflamed, you may have symptoms such as:

·         a poor appetite

·         weight loss

·         abdominal pain

·         physical weakness

·         fatigue

·         confusion

If fatty liver progresses to cirrhosis and liver failure, symptoms can include:

·         an enlarging, fluid-filled abdomen

·         jaundice of the skin and eyes

·         confusion

·         abnormal bleeding

What are the causes of fatty liver?

The most common cause of fatty liver is alcohol use disorder and heavy drinking. In many cases, it’s much less clear what causes fatty liver in people who don’t drink much alcohol. However, higher body weight, a high processed sugar diet, high triglycerides, diabetes, low physical activity, and genetics all play a role.

Fatty liver develops when the body creates too much fat or cannot metabolize fat efficiently enough. The excess fat is stored in liver cells where it accumulates and causes fatty liver disease.

Besides alcohol use disorder, other common causes of fatty liver include:

·         obesity

·         hyperlipidemia, or high levels of fats in the blood, especially high triglycerides

·         diabetes

·         genetic inheritance

·         rapid weight loss

·         side effects of certain medications, including methotrexate (Trexall), tamoxifen (Nolvadex), amiodorone (Pacerone), and valproic acid (Depakote)

What are the types of fatty liver?

There are two basic types of fatty liver: non-alcoholic and alcoholic.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) develops when the liver has difficulty breaking down fats, which causes a build up in the liver tissue. The cause is not related to alcohol. NAFLD is diagnosed when more than 5 percent of the liver is fat.

Non-alcoholic steatohepatitis (NASH)

Non-alcoholic steatohepatitis (NASH) is a type of NAFLD. As fat builds up, it can cause inflammation. Once more than 5 percent of the liver is fat and inflammation is also present, the condition is known as NASH.

Non-alcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of non-alcoholic fatty liver disease is too much fat stored in liver cells.

Non-alcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, non-alcoholic steatohepatitis can progress to cirrhosis and liver failure

Non-alcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.

Non-alcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat.

Symptoms of this condition are related to inflammation and worsening liver function. These can include:

·         appetite loss

·         nausea

·         vomiting

·         abdominal pain

·         jaundice

If left untreated, steatohepatitis can progress to permanent scarring of the liver, liver cancer, and eventual liver failure.

Acute fatty liver of pregnancy

Acute fatty liver is a rare and potentially life-threatening complication of pregnancy.

Signs and symptoms begin in the third trimester. These include:

·         persistent nausea and vomiting

·         pain in the upper-right abdomen

·         headache

·         jaundice

·         general malaise

·         fatigue

·         decreased appetite

Women who are pregnant with any of these signs or symptoms should be evaluated for this condition. Treatment includes managing any complications and prompt delivery. Most women improve within several weeks after delivery and have no lasting effects.

Alcoholic fatty liver

Alcoholic fatty liver is the earliest stage of alcohol-related liver disease. Heavy drinking damages the liver, and the liver cannot break down fats as a result. Abstaining from alcohol will likely cause the fatty liver to subside. Within six weeks of not drinking alcohol, the fat can disappear. However, if excessive alcohol use continues, inflammation known as alcoholic steatohepatitis may develop, leading to cirrhosis.

Causes

Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following:

·         Overweight or obesity

·         Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin

·         High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes

·         High levels of fats, particularly triglycerides, in the blood

These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver.

Risk factors

A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including:

·         High cholesterol

·         High levels of triglycerides in the blood

·         Metabolic syndrome

·         Obesity, particularly when fat is concentrated in the abdomen

·         Polycystic ovary syndrome

·         Sleep apnea

·         Type 2 diabetes

·         Underactive thyroid (hypothyroidism)

·         Underactive pituitary gland (hypopituitarism)

Nonalcoholic steatohepatitis is more likely in these groups:

·         Older people

·         People with diabetes

·         People with body fat concentrated in the abdomen

It is difficult to distinguish nonalcoholic fatty liver disease from nonalcoholic steatohepatitis without further testing.

Complications

The main complication of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is cirrhosis, which is late-stage scarring (fibrosis) in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in nonalcoholic steatohepatitis.  As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue.

If the process isn't interrupted, cirrhosis can lead to:

·         Fluid buildup in the abdomen (ascites)

·         Swelling of veins in your esophagus (esophageal varices), which can rupture and bleed

·         Confusion, drowsiness and slurred speech (hepatic encephalopathy)

·         Liver cancer

·         End-stage liver failure, which means the liver has stopped functioning

About 20 percent of people with non-alcoholic steatohepatitis will progress to cirrhosis.

Who’s at risk for fatty liver?

Fatty liver is the buildup of extra fats in the liver. It’s more likely to develop if you’re overweight or obese. Having type 2 diabetes also may increase your risk for fatty liver. Fat accumulation in the liver has been linked to insulin resistance, which is the most common cause of type 2 diabetes.

Other factors that may increase your risk for fatty liver include:

·         excessive alcohol use

·         taking more than the recommended doses of certain over-the-counter medications, such as acetaminophen (Tylenol)

·         pregnancy

·         high cholesterol

·         high triglyceride levels

·         malnutrition

·         metabolic syndrome

·         low physical activity

How is fatty liver diagnosed?

Physical exam

If your liver is inflamed, your doctor may be able to detect it by examining your abdomen for an enlarged liver. However, your liver can be inflamed without being enlarged. Let your doctor know if you’ve been experiencing fatigue or loss of appetite. Also, tell your doctor about any history of alcohol, medication, and supplement use.

Blood tests

Your doctor may find that liver enzymes are higher than normal during a routine blood test. This doesn’t confirm a diagnosis of fatty liver, but it does relate to liver inflammation. Further analysis is necessary to find the cause of the inflammation.

Imaging studies

Your doctor may use an ultrasound to detect fat in your liver. Other imaging studies may also be done, such as CT or MRI scans.

Another imaging test similar to ultrasound is a Fibro Scan. Like an ultrasound, a Fibro Scan utilizes sound waves to determine the density of the liver and the corresponding areas of fat and normal liver tissue.

Imaging studies can detect fat in the liver, but they cannot help your doctor confirm the extent of damage.

Liver biopsy

A liver biopsy is still considered the best way to determine the severity of liver disease. During a liver biopsy, your doctor will insert a needle into the liver and remove a piece of tissue for examination. They will give you a local anesthetic to lessen the pain.

A liver biopsy is the only way to know for certain the severity of fatty liver or other liver diseases. The biopsy can also help your doctor determine the exact cause.

How is fatty liver treated?

Research is ongoing into medications that may help treat fatty liver. The first-line of treatment continues to be following recommendations to reduce your risk factors. These recommendations typically include:

·         limiting or avoiding alcoholic beverages

·         managing your cholesterol and reducing your intake of sugars and saturated fats

·         losing weight

·         controlling your blood sugar

If you have fatty liver because of obesity or unhealthy eating habits, your doctor may also suggest that you increase physical activity and eliminate or add certain types of foods to your diet. Reducing the number of calories you eat each day can help you lose weight and heal your liver.

In the early stages, you can improve and reverse fatty liver disease by reducing or eliminating fatty foods and foods high in sugar from your diet. Choose a balanced diet with healthier foods such as fresh fruits, fresh vegetables, whole grains, and healthy fats like those in nuts and avocados. Replace red meats with lean proteins such as soy, chicken, turkey, and fish. Sweetened drinks, juices, and sodas should be avoided.

What is the long-term outlook for fatty liver?

Most cases of fatty liver don’t progress into other forms of liver disease. The liver can repair itself, so if you take the necessary steps to treat high cholesterol, diabetes, an unhealthy diet, and obesity, you can reverse fatty liver.

If you’re a heavy drinker, stop drinking alcohol or limit your intake to 1 drink or less per day for women and 2 drinks or less per day for men. A liver biopsy can help your doctor identify permanent liver damage, and determine the severity of damage.

If fatty liver persists and is not reversed, it can progress into liver disease, cirrhosis, or cancer. The progression to cirrhosis is dependent on the cause. In alcoholic fatty liver, continuing to drink alcohol in excess can lead to liver failure.

The progression of non-alcoholic fatty liver disease varies, but in most people it does not lead to liver scarring and cirrhosis. However, if you’re diagnosed with steatohepatitis, you have a higher chance of developing scarring and liver disease. Twenty percent of people with steatohepatitis will go on to develop worsening liver disease.

If fatty liver progresses to cirrhosis, the risk of liver failure and death rises significantly. There is also a higher risk for liver cancer and death from heart disease.

How do I prevent fatty liver disease?

Protecting your liver is one of the best ways to prevent fatty liver and its complications. You can start by taking several steps:

·         limit or eliminate alcohol from your diet

·         eat a healthy, balanced diet

·         control diabetes if you have developed the condition

·         aim for at least 30 minutes of exercise most days of the week

By taking these steps, you’ll not only keep your liver healthy but also improve your overall health.

12 foods and drinks that you should eat for a fatty liver

Here are a few foods to include in your healthy liver diet:

1. Coffee to lower abnormal liver enzymes

Studies have shown that coffee drinkers with fatty liver disease have less liver damage than those who don’t drink this caffeinated beverage. Caffeine appears to lower the amount of abnormal liver enzymes of people at risk for liver diseases.

2. Greens to prevent fat build up

Broccoli is shown to help prevent the build up of fat in the liver in mice. Eating more greens, like spinach, Brussels sprouts, and kale, can also help with general weight loss. Try the Canadian Liver Foundation’s recipe for vegetarian chili, which lets you cut back on calories without sacrificing flavor.

3. Tofu to reduce fat build up

A University of Illinois study on rats found that soy protein, which is contained in foods like tofu, may reduce fat build up in the liver. Plus, tofu is low in fat and high in protein.

4. Fish for inflammation and fat levels

Fatty fish such as salmon, sardines, tuna, and trout are high in omega-3 fatty acids. Omega-3 fatty acids can help improve liver fat levels and bring down inflammation. Try this teriyaki halibut recipe, recommended by the Canadian Liver Foundation, that’s especially low in fat.

5. Oatmeal for energy

Carbohydrates from whole grains like oatmeal give your body energy. Their fiber content also fills you up, which can help you maintain your weight.

6. Walnuts to improve the liver

These nuts are high in omega-3 fatty acids. Research finds that people with fatty liver disease who eat walnuts have improved liver function tests.

7. Avocado to help protect the liver

Avocados are high in healthy fats, and research suggests they contain chemicals that might slow liver damage. They’re also rich in fiber, which can help with weight control. Try this refreshing avocado and mushroom salad from Fatty Liver Diet Review.

8. Milk and other low-fat dairy to protect from damage

Dairy is high in whey protein, which may protect the liver from further damage, according to a 2011 study in rats.

9. Sunflower seeds for antioxidants

These nutty-tasting seeds are high in vitamin E, an antioxidant that may protect the liver from further damage.

10. Olive oil for weight control

This healthy oil is high in omega-3 fatty acids. It’s healthier for cooking than margarine, butter, or shortening. Research finds that olive oil helps to lower liver enzyme levels and control weight. Try this liver-friendly take on a traditional Mexican dish from LiverSupport.com.

11. Garlic to help reduce body weight

This herb not only adds flavor to food, but experimental studies also show that garlic powder supplements may help reduce body weight and fat in people with fatty liver disease.

12. Green tea for less fat absorption

Data supports that green tea can help interfere with fat absorption, but the results aren’t conclusive yet. Researchers are studying whether green tea can reduce fat storage in the liver and improve liver function. But green tea also has many benefits, from lowering cholesterol to aiding with sleep.

6 foods to avoid if you have a fatty liver

There are definitely foods you should avoid or limit if you have fatty liver disease. These foods generally contribute to weight gain and increasing blood sugar.

Avoid

·         Alcohol. Alcohol is a major cause of fatty liver disease as well as other liver diseases.

·         Added sugar. Stay away from sugary foods such as candy, cookies, sodas, and fruit juices. High blood sugar increases the amount of fat buildup in the liver.

·         Fried foods. These are high in fat and calories.

·         Salt. Eating too much salt can make your body hold on to excess water. Limit sodium to less than 1,500 milligrams per day.

·         White bread, rice, and pasta. White usually means the flour is highly processed, which can raise your blood sugar more than whole grains due to a lack of fiber.

·         Red meat. Beef and deli meats are high in saturated fat.

Additional ways to treat liver disease

In addition to modifying your diet, here are a few other lifestyle changes you can make to improve your liver health:

1.     Get more active. Exercise, paired with diet, can help you lose extra weight and manage your liver disease. Aim to get at least 30 minutes of aerobic exercise on most days of the week.

2.     Lower cholesterol. Watch your saturated fat and sugar intake to help keep your cholesterol and triglyceride levels under control. If diet and exercise aren’t enough to lower your cholesterol, ask your doctor about taking medication.

3.     Control diabetes. Diabetes and fatty liver disease often occur together. Diet and exercise can help you manage both conditions. If your blood sugar is still high, your doctor can prescribe medication to lower it.

Takeaway

There are currently no drugs on the market that are approved by the U.S. Food and Drug Administration for fatty liver disease. While losing 10 percent of your weight is ideal, even just 3 to 5 percent can help. Ask your doctor to check your blood for the hepatitis A and B vaccines as well. These can help prevent viruses from causing liver damage.