Fatty Liver - Stages, Symptoms, Causes, Test & Treatment

The liver is responsible for filtering toxins in the blood. In a healthy liver, only a small amount of fat is present. It helps store energy and digest food. 

Fatty liver disease is a condition in which excess fat accumulates in the liver. This can impair the liver function.

There are four main types of fatty liver conditions. These are categorised based on the cause of fat buildup in the liver:

1. Alcohol-related Fatty Liver Disease (ALD): Caused by excessive alcohol consumption damaging liver cells and leading to fat accumulation.

2. Non-alcoholic Fatty Liver Disease (NAFLD): This happens when excess fat builds up in the liver. Heavy alcohol is not the root cause here.

3. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Linked to cardiometabolic risk factors like:

1. Obesity

2. Type 2 diabetes

3. High blood pressure

4. Low alcohol intake (less than recommended amounts) can contribute to MASLD also.

4. Metabolic-Associated Steatohepatitis (MASH): A more severe form of MASLD where fat buildup progresses to inflammation, cell damage, and scarring (fibrosis).

5. MetALD (MASLD with Increased Alcohol Intake): Caused by both metabolic risk factors and exceeding recommended alcohol intake levels.

Fatty Liver Grades

The fatty liver grades are based on the percentage of fat stored in the liver cells. This grading system helps doctors assess the severity of the condition and provide treatment plans.

1. Grade 1 Fatty Liver (Mild Steatosis): This is the mildest form, with fat accumulation ranging from 5% to 33% of the liver cells. Typically, there are no symptoms at this stage.

2. Grade 2 Fatty Liver (Moderate Steatosis): Fat makes up 34% to 66% of the liver cells in this stage. Some people may experience fatigue, discomfort in the upper right abdomen, or feeling unwell.

3. Grade 3 Fatty Liver (Severe Steatosis): This is the most severe grade, with fat exceeding 66% of the liver cells. The risk of complications like inflammation and scarring (fibrosis) increases at this stage.

Fatty liver symptoms often are not visible in the early stages. If they do occur, signs may be general and mild. Additionally, the speed of progression can vary due to individual factors. People during this time may experience:

1. Fatigue

2. General discomfort or malaise

3. Pain in the upper right abdomen

NASH progresses at 1 stage every 7 years. Therefore, if the condition results in NASH (inflamed liver) or cirrhosis (severe scarring), symptoms may include:

1. Itchy skin

2. Abdominal swelling (ascites)

3. Shortness of breath

4. Leg swelling

5. Red palms

6. Yellowing of the skin and eyes (jaundice)

The exact reasons why fat accumulates in the liver and why some cases progress to NASH are still being studied. However, there are several reasons why people get different fatty liver stages, which are linked to both: 

1. Heavy Alcohol Use: Consumption of alcohol disrupts the normal metabolic pathways of the liver. This hinders its ability to process and eliminate fat effectively.

2. Non-alcoholic Causes: Possible causes include excess fat production, poor fat metabolism, or factors like:

1. High triglycerides

2. Metabolic syndrome

Other potential causes include pregnancy, medications, hepatitis C, and rare genetic conditions.

Fatty Liver Risk Factors

Many health-related issues and lifestyle factors can increase the chances of SLD developing. These fatty liver causes include modifiable and non-modifiable factors.

Modifiable risk factors can change through lifestyle modifications, such as diet and exercise. These include:

1. Metabolic Syndrome: A group of abnormalities that can significantly increase SLD risk:

1. Insulin resistance

2. High blood pressure

3. Abnormal cholesterol levels

4. Elevated blood sugar

2. Obesity: Excess body weight, particularly with fat concentrated around the waist, is a significant risk factor for steatotic liver disease.

3. Dyslipidemia: High triglyceride levels (blood fat) and low HDL cholesterol are associated with fatty liver issues.

4. Type 2 Diabetes: High blood sugar levels are associated with type 2 diabetes. This is a major risk factor for SLD.

Non-modifiable risk factors are those that cannot change. It is important to talk to the doctor about how to manage them.

1. Polycystic Ovary Syndrome (PCOS): This hormonal imbalance in women can disrupt insulin sensitivity and contribute to NAFLD (nonalcoholic fatty liver disease) development.

2. Thyroid Dysfunction: Both hypothyroidism (underactive thyroid) and hypopituitarism (underactive pituitary gland) can affect fat metabolism.

3. Growth Hormone Deficiency: Inadequate growth hormone production can disrupt fat metabolism and contribute to SLD.

4. Family History: Having a close relative with just grade 1 fatty liver or obesity increases the risk, suggesting a potential genetic component.

Note: The presence of one risk factor does not guarantee SLD development. However, multiple risk factors need to be discussed with a hepatologist for screening and potential intervention.

Nonalcoholic fatty liver disease is a preventable condition. Here are key strategies to promote liver health:

1. Healthy Weight: Aim for gradual weight loss through healthy eating and exercise. This reduces excess fat storage in the liver. Focus on whole grains, fruits, vegetables, and lean protein. This provides essential nutrients for healthy liver function and avoids overloading it with processed fats and sugars.

2. Physical Activity: Engage in regular moderate-intensity exercise like brisk walking or cycling. Exercise helps your body burn fat more efficiently, reducing the amount stored in the liver.

3. Blood Sugar: Manage prediabetes or type 2 diabetes through medication, diet, and exercise. Uncontrolled blood sugar can contribute to fat accumulation in the liver.

4. Alcohol Consumption: Limit alcohol intake or abstain completely. Excessive alcohol intake can overwhelm the processing ability of the liver, leading to fat accumulation.

5. Cholesterol: Focus on a heart-healthy diet and discuss medication with a doctor if needed. High cholesterol can contribute to fatty deposits in the liver.

A doctor looks for fatty liver causes by combining patient history, physical examination, and various tests. This often involves a multi-step approach to assessing risk factors and potential damage. 

1. Patient History: The doctor will inquire about the patient's medical record, including family history of liver disease, diabetes, and obesity. They will also discuss diet, exercise habits, and alcohol consumption.

2. FibroScan: Measures liver stiffness, potentially indicating fibrosis severity.

3. Ultrasound: Sound waves could be used to assess liver stiffness. This is done to visualise fat accumulation and assess for potential scarring.

4. Computed Tomography (CT) Scanning: Can show differences in liver size and shape between simple steatosis and NASH.

Note: The specific tests advised may vary depending on the patient’s situation and doctor's recommendation.

How to prepare for the doctor's consultation? 

A well-prepared consultation can improve the doctor's understanding of the patient's condition. This would lead to a more effective diagnosis and treatment plan. Here is how to get ready for an appointment:

1. List of Concerns: Write down a list of symptoms being experienced, including when they started and their severity.

2. Prepare Questions: Formulate questions to be asked, such as risk factors, treatment options, and potential complications.

Questions to Ask the Doctor 

Inquiring during the consultation can aid patients in gaining a deeper comprehension of their condition and clarifying their available treatment choices. Take into account the following questions:

1. Are there any specific medications or treatments available to alleviate symptoms or slow the progression of fatty liver disease?

2. What lifestyle changes can be effective in improving fatty liver health?

3. How frequently should I undergo screenings or tests to monitor the progression of my fatty liver condition?

4. What are the potential complications or risks associated with fatty liver disease, and how can they be mitigated?

The treatment of fatty liver depends on the grade at which the disease is diagnosed. If found early, it can be managed through lifestyle modifications. 

1. Nonsurgical Options

The doctor will decide on a plan of action based on the specific case. In most cases, the hepatologist might suggest losing 7% of body weight in 6 months. 

Depending on the situation, doctors may discuss managing blood sugar, reducing alcohol intake, or addressing cholesterol. Eating a balanced diet, exercising regularly, and prioritising quality sleep would also be recommended. 

2. Surgery 

Advanced complications like cirrhosis (scarring) or liver failure would require surgical intervention. 

1. Liver Transplant: For people with nonalcoholic steatohepatitis (NASH)-related advanced cirrhosis transplant may be required. This is the only option for treating severe liver failure caused by NASH.

Fatty liver disease (NAFLD) is often a silent condition. However, over time, neglecting NAFLD can lead to serious health complications. It includes:

1. Progression to NASH (Nonalcoholic Steatohepatitis): Left untreated, NAFLD can progress to NASH. This could cause inflammation and liver cell damage. 

2. Increased Risk of Liver Fibrosis: Chronic inflammation due to NASH can lead to fibrosis. Here, the healthy liver tissue is replaced by scar tissue.

3. Liver Failure: Fibrosis, if left untreated, can progress to cirrhosis. It is a severe condition and can disrupt essential liver functions, leading to liver failure.

Note: Early diagnosis and understanding of how to reduce fatty liver can help prevent risk in case the condition is not severe. Speak with a doctor to understand the symptoms well.

When to consult a doctor?

Early detection and intervention are important to manage or prevent fatty liver and preventing complications. Consult a doctor if experiencing any of the following:

1. Unexplained fatigue

2. Loss of appetite

3. Sudden weight loss

4. Nausea or vomiting

5. Abdominal pain or tenderness in the upper right abdomen

Following a balanced, nutritious diet is crucial for managing fatty liver disease (NAFLD). This dietary approach promotes weight loss, reduces inflammation, and improves liver health.

Eat the following fatty liver diet to reduce NAFLD risk:

1. Fruits like berries

2. High-fibre plants

3. Healthy fats like olive oil, fatty fish

4. Nuts like walnuts 

Fatty liver, or NAFLD, is a growing concern in India. This condition arises from excess fat accumulation in the liver, potentially impairing function. Early detection and intervention are crucial for preventing complications like inflammation and scarring.

If you are concerned about your liver health, consult a doctor. Discuss your fatty liver symptoms and get screened for NAFLD. HexaHealth can be your partner here. We connect you with qualified doctors and healthcare providers specialising in liver health. You can find the information and assistance to manage your condition and improve your overall health with us.

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