Fatty Liver

What Is Fatty Liver?

Fatty liver occurs when too much fat builds up inside the liver cells. When a person consumes more fat than the body needs, or when certain medical conditions cause excess fat to accumulate, the fat gradually builds up in body tissues, including the liver. Fatty liver affects approximately 10% to 24% of people worldwide, and its prevalence is increasing rapidly in Bangladesh. When fat makes up about 5% to 10% of the liver, the condition is generally referred to as fatty liver.

Fatty liver is common (benign condition) and may not cause any immediate liver damage. However, once excess fat begins to accumulate, it can make liver cells more vulnerable to injury. Over time, this may lead to inflammation and scarring of the liver. The damage can develop slowly and silently and may eventually become serious.

(A silent disease with silent epidemic.)

What Are the Symptoms of Fatty Liver Disease?

Most people with fatty liver disease do not have any symptoms. However, some people may experience:

  • A feeling of discomfort or heaviness in the upper right side of the abdomen, where the liver is located
  • Restlessness or a general feeling of being unwell
  • Tiredness or fatigue
  • General discomfort
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How Is Fatty Liver Diagnosed?

Fatty liver may be suspected when a person has:

  • An enlarged liver
  • Abnormal liver function test results (ALT/SGPT levels may be abnormally high)

An abdominal ultrasound can often detect fatty liver. In many cases, FibroScan can also help detect and assess fatty liver and non-alcoholic steatohepatitis (NASH). In some cases, a liver biopsy may be necessary. During a liver biopsy, a small sample of liver tissue is taken using a needle and examined under a microscope.

BMI: Know It and Check It

Body Mass Index (BMI) is one of the most commonly used methods for assessing whether a person is underweight, at a healthy weight, overweight, or obese.

BMI is calculated using a person's weight in kilograms and height in meters:

BMI = Weight (kg) ÷ Height (m)²

For most adults, a BMI of 18.5 to 24.9 is considered within the healthy range and a BMI of 30 to 39.9 falls within the obesity range.

What Causes Fatty Liver Disease?

Obesity is one of the major causes of fatty liver disease. Additionally, other possible causes include:

  • Severe starvation or malnutrition, including protein deficiency
  • Long-term parenteral nutrition, in which nutrients are given directly through a vein
  • Rapid weight loss
  • Intestinal bypass surgery performed for weight loss
  • Heavy alcohol consumption

Besides these, certain medical conditions can also contribute to the development of fatty liver disease. These include:

  • Diabetes
  • High levels of fat in the blood, known as dyslipidemia
  • Hypothyroidism, or an underactive thyroid gland
  • High blood pressure

Can Fatty Liver Disease Be Prevented?

Yes. Fatty liver disease can often be prevented or reduced through a healthy lifestyle. Because obesity is a major risk factor, maintaining a healthy weight is important. A healthy diet and regular physical activity are especially important.

Guidelines for Preventing Fatty Liver Disease

  • Follow a healthy lifestyle.
  • If you are overweight, lose weight gradually and consistently. Seek advice from a qualified nutritionist or healthcare professional about managing your weight.
  • Eat a balanced diet that is low in saturated fat and rich in fiber.
  • Exercise at least four times a week. Regular activities such as walking, swimming, and cycling can be beneficial.
  • Keep high levels of fat in the blood (dyslipidemia) under control.
  • Avoid alcohol.
  • If you have hypothyroidism, seek appropriate treatment.

How Is Fatty Liver Disease Treated?

Treatment for fatty liver disease mainly depends on what is causing it. It can be difficult to predict from the beginning which patients will develop a more serious form of the disease. Therefore, it is important to identify and treat the underlying cause and maintain a healthy lifestyle.

Depending on the person's condition, treatment may include:

  • Gradual weight loss when appropriate
  • A healthy, balanced diet
  • Regular physical activity
  • Treatment of diabetes and abnormal blood fat levels
  • Treatment of hypothyroidism when present
  • Avoiding alcohol
  • Regular medical follow-up

Early attention to fatty liver can help reduce the risk of long-term liver damage.

What Are NAFLD and NASH?

Non-alcoholic fatty liver disease (NAFLD) refers to fatty liver disease that occurs in people who do not have significant alcohol-related liver disease. Fat accumulation in the liver is common and may remain relatively mild. However, when the fatty liver becomes associated with inflammation and liver-cell injury, it is called non-alcoholic steatohepatitis (NASH). NASH is estimated to affect approximately 2% to 6% of the general population. Among adults with NASH, approximately 20% may develop liver cirrhosis, while around 11% may die from complications of liver disease or liver cancer. In Bangladesh, the prevalence of NAFLD is estimated to be approximately 33.86%, meaning that about one-third of the population may be affected. People with NAFLD, particularly those who develop NASH, may face a serious risk of developing:

  • Liver inflammation
  • Liver fibrosis and scarring
  • Liver cirrhosis
  • Liver cancer

The same healthy lifestyle measures used to prevent fatty liver disease can also help prevent or reduce the risk of NASH.

In some cases, people with NAFLD or NASH can develop long-term liver failure. When the liver becomes severely damaged and can no longer function properly, liver transplantation may eventually be necessary.

If the disease progresses to advanced cirrhosis or liver cancer, a liver transplant may be one of the only treatment options for some patients. Today, NASH-related cirrhosis is among the major causes of liver transplantation worldwide. If current trends continue, NASH-related cirrhosis may become an even more common reason for liver transplantation over the next 15 to 20 years.

Unfortunately, not every patient with advanced NASH or its complications is a suitable candidate for liver transplantation. Finding a suitable donor organ can also be difficult, and transplantation itself carries significant risks.