Fatty liver disease, as the name implies, is the accumulation of fat in the liver. But what happens if you have this condition and what are the risk factors for developing Fatty Liver Disease?
What is Fatty Liver Disease?
Two primary types of fatty liver disease have been observed: one that is associated with excessive ingestion of alcoholic beverages (Alcoholic Fatty Liver Disease) and one that is not (Non-Alcoholic Fatty Liver Disease).
Fatty liver disease may be asymptomatic, depending on the cause and severity of the disease, which will eventually lead to inflammation and damage of the hepatic cells.
As of 2018, the global prevalence of non-alcoholic liver disease is 25%. Non-alcoholic liver disease is slowly becoming the leading cause of cirrhosis requiring liver transplantation. The incidence of non-alcoholic liver disease is also steadily rising, which may be associated with the increased prevalence of associated/predisposing conditions such as
- Obesity
- Diabetes mellitus type 2
- Metabolic syndrome.
As for alcoholic liver disease, an accurate metric as to its incidence and prevalence is difficult to estimate, since many cases are asymptomatic.
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Types of Fatty Liver Disease
The difference between alcoholic and non-alcoholic liver disease can be seen in its risks, presentation, pathophysiology, and outcomes.
Non-alcoholic fatty liver disease (NAFLD)
- Is the type of fatty liver disease that occurs in the absence of copious/chronic alcohol ingestion.
- Simple fatty liver is a presentation in which fat builds up in the liver but inflammation and liver damage is not evident; these patients are usually healthy/asymptomatic
- Non-alcoholic Steatohepatitis (NASH) refers to fatty liver disease that develops with inflammation and damage to hepatocytes (liver cells). This, in turn, may lead to the development of fibrosis or scarring of the liver. The worst prognosis for this disease would be liver cirrhosis or liver cancer.
Alcoholic fatty liver disease
- This form of fatty liver disease is related to copious/ excessive alcohol consumption.
- As patients consume alcoholic beverages, it is absorbed in the gut and processed by the liver, where ethanol (the alcohol seen in hard beverages) is metabolized into acetaldehyde, a major toxic metabolite, which is a principal culprit in mediating the fibrogenic and mutagenic effects of alcohol in the liver.
- Substances such as this will damage the liver over time and is directly proportional to the amount of alcohol ingested.
- This condition leads to alcoholic hepatitis (inflammation) and cirrhosis.
Liver cirrhosis is one of the most dreaded effects. In this condition, chronic damage to the liver eventually leads to the formation of fibrous bands of tissue due to regeneration of liver tissue. The treatment for patients with severe liver cirrhosis is liver transplantation.
Risk Factors for Developing Fatty Liver Disease
Many risk factors can be attributed to the development of fatty liver disease. For alcoholic fatty liver disease, chronic and/or copious alcohol consumption eventually leads to the development of the disease. However, there are controllable and uncontrollable risk factors that we can account for when discussing the development of fatty liver disease, these are:
Controllable factors
- Obesity – Increases fat build-up
- Medication use – Specifically corticosteroids and some chemotherapeutic medications (used in cancer therapy)
- Non-approved herbal medications can cause liver damage.
- Exposure to hepatotoxic chemicals such as carbon tetrachloride (dry cleanings solvent), paraquat (herbicide), vinyl chloride, and polychlorinated biphenyls.
- Rapid weight loss, as stated in some studies, can cause increases in ALT and AST (biomarkers for liver function). This is also called transaminitis. This is usually seen in patients who practice crash diets. Liver damage is seen in patients who lose at least 4 pounds a week or more.
Uncontrollable factors
- High triglyceride levels
- Low blood levels of High Density Lipoproteins (HDL), which is known as your “good cholesterol,” since it absorbs cholesterol and carries it back to the liver.
- Hypertension – Related to the increase in insulin resistance and body weight in these patients
- Type 2 Diabetes Mellitus (DM) – This is due to the obesity and insulin resistance seen in these patients.
- Age – Typically seen in patients 30-70 years old, peaking at 50-60 years old for men and 30-40 years old for women.
- Metabolic syndrome – A cluster of risk factors that increases the likelihood of patients to develop atherosclerotic cardiovascular disease, diabetes mellitus, chronic kidney disease, and fatty liver disease. This includes insulin resistance, central adiposity, increased BMI, hypertension, and hyperlipidemia. Its predisposition to the development of fatty liver disease is related to the increase in insulin resistance and obesity seen in these patients.
- Hepatitis C infection can increase fat deposition near the portal areas of the liver. People with Hepatitis C Infection, who have/had steatosis, tended to show a pattern of fatty deposition around portal areas of the liver. Fatty liver disease contributes to the progression of hepatitis C.
Prevention
The likelihood of developing Fatty Liver Disease can be lowered with
- Adequate weight loss and blood sugar control
- Avoiding copious or chronic intake of alcohol
- Proper exercise in the attempt to lose weight
- Avoiding diet fads that may cause liver damage.
- Preventing liver infections with the hepatitis vaccine may also be effective in preventing fatty liver disease.
- Some medications can be used in the prevention of Fatty Liver Disease. For example, patients may be prescribed with metformin prior to the development of diabetes in order to help decrease the risk of developing diabetes and aid the patient in weight loss, which is also beneficial in reducing the risk of Fatty Liver Disease development.
Note: It has not been fully proven that Metformin can decrease risk of liver disease. Seek the guidance of your doctor to control risk factors that may contribute to the development of the disease.
Key Takeaways
Fatty Liver Disease is a serious medical condition that usually is asymptomatic until the patient has developed severe liver damage in the form of hepatic steatosis or liver cirrhosis.
Many risk factors, most of which are related to lifestyle, lead to the development of Fatty Liver Disease. Poor health decisions that lead to the development of obesity and eventually hypertension, diabetes, and increased visceral adiposity, predisposes the patient to the development of the disease.
Lifestyle modification through diet, exercise, abstaining from alcohol, and vaccination play a role in decreasing the risk factors for developing Fatty Liver Disease.
Learn more about Digestive Health here.
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