Understanding Fatty Liver

Magin Alexander, MD, is an internal medicine physician at Washington Health Medical Foundation. She sees patients in the Warm Springs clinic. A primary care physician with a special interest in preventive care, Dr. Alexander combines evidence-based medicine, compassion and partnership to provide patient-centered care. She shares her experience and knowledge regarding liver health.

Fatty liver disease is a growing health concern in our community, affecting an estimated 20–30% of adults in the United States. While often silent in its early stages, this condition can lead to serious complications if left unchecked.
What Is Fatty Liver Disease?

Fatty liver, also known as hepatic steatosis, occurs when excess fat builds up in the liver, which is identified by radiologic imaging or by liver biopsy. A small amount of fat is normal, when fat infiltration exceeds 5–10% of the liver cells, it becomes a concern.
What are the types of fatty liver disease?

There are two main types of fatty liver disease.

• Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD). This is found in individuals who consume little or no alcohol. It is often linked to obesity, diabetes, high cholesterol, high blood pressure and sedentary lifestyle.
• Alcoholic fatty liver disease (AFLD), is caused by excessive alcohol consumption which damages liver cells and leads to fat accumulation.

Why is it a concern?

In most cases, fatty liver does not cause significant liver dysfunction. In certain cases fat accumulation can progress to liver cell inflammation called steatohepatitis. This may also lead to scarring or fibrosis of liver tissue. Extensive liver damage can even lead to cirrhosis.

How can it be diagnosed?

Most people with fatty liver disease experience no initial symptoms. When symptoms do occur, they may include fatigue or vague discomfort in the upper right abdomen.

Patients may experience symptoms like nausea, jaundice, weight changes, abdominal or leg swelling, if fatty liver disease progresses to cirrhosis or complications.

Fatty liver is usually suspected based on elevated liver enzymes (ALT and AST) on a blood test, and confirmed with imaging like ultrasound or, in some cases, MRI or FibroScan. A liver biopsy is rarely needed, but may be used in uncertain or advanced cases.
Who Is at Risk?

You may be at higher risk if you:

• Are overweight or obese
• Have type 2 diabetes or prediabetes
• Suffer from high blood pressure or high cholesterol
• Have poor dietary habits or lead a sedentary lifestyle
• Consume alcohol excessively

Can it be treated?

The good news is that fatty liver disease can often be managed or even reversed with lifestyle changes:

• Weight loss: Weight loss is the primary therapy for most patients with MASLD. Gradual weight loss of one to two pounds per week is recommended for patients who are overweight (BMI] ≥25 kg/m2) or obese (BMI ≥30 kg/m2). Losing 5-10% of body weight can lead to improvement in liver tests and quality of life in patients with MASLD.
• This can be achieved through lifestyle modifications including dietary modifications and regular exercise. Focus on a healthy diet and avoid high sugar intake. Aim for at least 30 minutes of moderately intense exercise for most days of the week.
• Alcohol abstinence: Refraining from alcohol, particularly heavy alcohol use. Heavy alcohol use is associated with disease progression.
• Immunization: Vaccination against hepatitis A virus and hepatitis B virus is recommended in patients who lack evidence of immunity. Check with your provider to see if you require vaccinations.Control of diabetes, cholesterol, and blood pressure: Seek medical advice on how to control these health factors.Other interventions like medications for weight loss or bariatric surgery are considered in certain patient populations with fatty liver disease and persistent weight gain despite lifestyle modification.

In Summary

Early detection and intervention can make a big difference when dealing with liver health. Regular health checkups, early diagnosis, and proactive lifestyle choices can prevent complications.

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