How is fatty liver diagnosed & how to treat it

Fatty liver tests and treatment

 With rising obesity rates and sedentary lifestyle in a large portion of population, adverse outcomes have also increased, obesity and unbalanced diet along with lack of physical activity has led to a plethora of medical issues not faced earlier.

The emerging but not yet too much emphasized concern, at this point, is, Fatty Liver Disease (FLD)”.

 What is fatty liver?

As the name suggests, fatty liver, is a medical condition in which excess fat is accumulated onto the liver. In medical terms, it is broadly labelled into 2 categories.

AFLD: Alcoholic fatty liver disease, that occurs in response to excess alcohol intake  

NAFLD: Non-Alcoholic fatty liver disease, occurs in individual, even non-alcoholic individuals, we will be mostly discussing this variant.

 

Should I be worried about Fatty Liver, is it  it dangerous?

Nonalcoholic fatty liver disease (NAFLD) encompasses a number of liver related disorders, the initial and most common is the fatty liver disease, in which, only excess fats are deposited in liver, but medical tests don’t reveal any abnormality in the liver functions.

Disease progression can lead to Liver inflammation called non-alcoholic steatohepatitis (NASH) which is an advanced form of liver disease, finally leading to Liver cirrhosis where normal liver structure and function is compromised.

Apart from the liver cirrhosis, Liver cancer, known as Hepatocellular carcinoma (HCC) is also linked to NAFLD.

In western countries, Liver failure secondary to NAFLD is the most common indication for liver transplantation. In developing countries e.g. Pakistan it is the third most common cause of cirrhosis and liver cancer after Hepatitis B and Hepatitis C.

 What are the signs and symptoms of fatty liver disease?

Initially fatty liver disease doesn’t cause any specific symptoms, mild symptoms e.g. fatigue and mild upper abdominal pain can occur, but these are non-specific.

Once the disease has progressed and cirrhosis sets in, its complications like abdominal distension, bleeding from the GI tract and drowsiness can occur, apart from other signs like yellowness of eyes, red palms etc.

 

What are the tests for diagnosis of fatty liver disease?

We frequently get asked “what are the tests of fatty liver”, “do liver function tests tell about fatty liver”, "what are the names of fatty liver blood tests".

Fatty liver can be diagnosed by medical investigations, namely blood tests and abdominal imaging via different modalities.

The blood tests done as part of the fatty liver disease workup are

CBC or the complete blood count.

LFTS’S, the liver function tests which consists of bilirubin, ALT, AST, ALBUMIN, ALP, GGT and proteins.

Fatty liver can be reliably diagnosed via abdominal imaging;

The first and frequently available investigation is the Ultrasound of the liver, this simple investigation can usually diagnose the fatty liver and the grade. It’s a non-invasive, quick, cheap and outpatient based investigation.

C.T scan and MRI liver can also be utilized as a next step in assessing the fatty liver or cirrhosis.

Sheerwave elastography is a variant of ultrasound used to assess liver stiffness that corresponds to the fibrosis.

Finally, among the invasive tests is the liver biopsy, which although not done as a routine, but is the most specific investigation for assessment. The liver biopsy involves taking a sample of liver via a needle and getting it analyzed in the laboratory.

 

Management and treatment of fatty liver disease

It should be noted that if you are diagnosed with the fatty liver disease or have a concern, you should get a proper check up from your concerned physician. People often ask us “what is the best medication for fatty liver”, unfortunately there is no easy answer. Currently, there is no specific medication that can cure fatty liver by itself. However, the general management involves more of lifestyle modification rather than medications.

Weight reduction:

Weight reduction is of paramount importance in the management of fatty liver disease, approximately 10% weight reduction is recommended in order to prevent fatty liver related complications. In the early stages, fatty liver is a reversible condition.

Diet:

No specific diet has been advocated for or against but in general a healthy balanced diet should be adhered too, with avoidance of processed food, sugars, alcohol and fast food.

Depending upon your doctor’s assessment some other interventions might be suggested on case to case basis which are outside of the domain of this article, e.g. diabetics need tight glycemic controls and switching to agents like GLP-1 agonists that seem to have multi-benefit of diabetic control as well as weight loss and improvement in liver dysfunction.

 

References:

https://pubmed.ncbi.nlm.nih.gov/27547937/

https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/