Fatty Liver Disease: Symptoms, Causes, and Treatment

The liver is the most vital organ of our body. The liver carries out all the metabolic activities of carbohydrates, fats, and proteins. It stores vitamins and minerals (e.g. Fat-soluble vitamins like A, D, E, K, and B12). When needed, the body converts and stores glucose in the liver as glycogen, and converts it back into glucose for energy use. Remove amino groups from amino acids, producing ammonia converted into urea for excretion. The liver breaks down carbohydrates into fatty acids and triglycerides. Then this fatty acid breaks down to produce energy. The liver also produces cholesterol and converts it into bile acids which helps in the digestion of food

Liver Foundation– Difference between Healthy Liver and Fatty Liver

The accumulation of excess fat in the liver causing inflammation and damage to cells results in Fatty liver. It also hampers the normal physiological functioning of the Liver. It is also known as silent liver disease because it can happen without showing any signs and symptoms

NAFLD: Understanding Non-Alcoholic Fatty Liver Disease

It occurs in non-alcoholic people when excess fat builds up in the liver. Obesity, insulin resistance type 2 diabetes, and high cholesterol are often associated with it.

Continental Hospitals– Fat deposition in the liver

What Causes Non-Alcoholic Fatty Liver Disease (NAFLD)?

Insulin resistance Type 2 diabetes

  • In a normal healthy person, the insulin produced by the pancreatic cell converts the carbohydrate into glucose and also helps to store it in the muscle, fat, and liver cells for later use.
  • But in insulin resistance, the cells do not respond to the insulin and hence do not allow the intake of glucose into the cells. 
  • Thus, the glucose level in the blood increases and to overcome that pancreas produces more insulin.
  • Then the extra insulin makes cells open up to store glucose. But over time the cells refuse to take and sugar piles up in the blood causing Type 2 Diabetes.
  • Several genetic and lifestyle aspects can contribute to insulin resistance.
  • The body converts glucose in the blood into fatty acids and forms triglycerides through numerous processes.
  • Three fatty acids and a glycerol molecule join to form a triglyceride.
  • These triglycerides accumulate in the liver causing Fatty liver.

Obesity 

  • High intake of fats and a sugar-based diet leads to an increased supply of free fatty acids to the liver. The liver synthesizes these free fatty acids into triglycerides.
  • The body stores excess fats in adipose tissue. When the capacity of adipose tissue is exceeded, it deposits excess fat in other organs, such as the liver.

Genetic Factor

  • Genetic differences among certain ethnic groups cause higher or lower prevalence rates of fatty liver in them.
  • Genes involved in various metabolic pathways such as lipid metabolism, insulin signalling, and inflammation, can influence the risk of developing NAFLD.

Alcoholic fatty liver disease (ALD)

Heavy alcohol drinkers develop alcoholic fatty liver disease, in which the liver accumulates fat. The metabolism of alcohol produces toxic byproducts, such as acetaldehyde and reactive oxygen species causing oxidation leading to cell damage and inflammation. 

Consuming more than 30 grams of alcohol per day in men and more than 20 grams per day in women leads to an increased risk of fatty liver.

Fatty Liver Disease Symptoms: Spotting the Signs of NAFLD and ALD

Tiredness

Excess fat in the liver does not accommodate the glycogen which is used when energy is needed and hence during physical activity our body do not meet sufficient energy and indirectly leading to shortness of breath and weakness. It does not store the vitamins as well resulting in the deficiencies of essential nutrients.

Abdominal pain

Fat accumulation in the liver can cause liver enlargement (hepatomegaly) and stretching of the organs leading to pain.

Hepatomegaly

Excess storage of fat in the liver cells increases the size of the liver.

Difference between Healthy liver and  Damaged liver
Difference between Normal Liver and Enlarged liver

Jaundice

In advanced stages, liver damage can impair bile processing, leading to its buildup in the blood and causing jaundice.

Weight loss

It occurs in the advanced stage, excess fats causes feeling of fullness and reduces appetite. The liver plays a key role in the metabolism and detoxification of metabolites produced by metabolism.  Liver damage affects digestion and alters the metabolism contributing to weight loss.

Spider angiomas

These are small, dilated blood vessels that appear near the surface of the skin and have a spider-like appearance with a central red spot and radiating lines. They are often signs of fatty liver disease.

Spider-like appearance known as Spider Angiomas
Spider Angiomas

Long-lasting itching

The disruption of bile function in the liver leads to the accumulation of bile salts in the bloodstream. These bile salts can deposit in the skin causing irritation and   itching. Impaired liver function accumulates the toxins in the blood causing itching. Deficiencies of vitamins which are essential for maintaining healthy skin can cause itching.

Fatty Liver Diagnosis: How it’s Detected

Medical History

Assess for risk factors like obesity, diabetes, hyperlipidemia, and metabolic syndrome

Liver Function Tests (LFTs)

When enzymes are released from the damaged liver into the bloodstream, elevated levels can be detected in blood tests. These enzymes are Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), Gamma-glutamyl transferase (GGT), Bilirubin, and Albumin.

Cholesterol check-up

Fatty liver can cause elevated levels of cholesterol and triglycerides.

Fasting blood sugar checkup

To check diabetes or insulin resistance which are the risk factors for fatty liver diseases.

Imaging tests

Ultrasound to detect the presence of excess fat in the liver, CT and MRI for further diagnosis, and FibroScan to measure the stiffness in the liver.

Biopsy

Taking a small piece of tissue to detect the severity of damage.

Treating Fatty Liver: Options for NAFLD and ALD

Non- Alcoholic Fatty Liver Disease 

Medications

  1. Metformin and pioglitazone are commonly used in treating fatty liver disease associated with type 2 diabetes.
  2. Anti-hyperlipidemic drugs: Used to manage cholesterol and triglyceride levels in the blood.
  3. Vitamin E: The antioxidant properties of Vitamin E help to reduce liver inflammation.

Lifestyle Modifications

  1. People prefer a calories-deficit diet, with foods such as leafy green vegetables, apples, citrus foods, berries, almonds rich in vitamin E, oats, and green tea.
  2. Avoid consuming packed and processed food with trans fat and low-density cholesterol (LDL), also known as bad cholesterol.
  3. Physical activity like cardio and resistance training can be beneficial in regulating fat metabolism.

Alcoholic Fatty Liver Disease

  1. AFLD is not treated with any medication.
  2. Stopping alcohol consumption entirely is one of and most crucial ways to reverse the disease.
  3. Carry out a healthy diet and engage in physical activity to make the liver healthy.

When a fatty liver progresses to cirrhosis leading to liver cancer, transplantation or surgical removal is the only way to prevent the spread of infection in the systemic circulation.

Reference

https://www.gastrojournal.org/article/S0016-5085(02)61906-7/fulltext?referrer=https%3A%2F%2Fwww.gastrojournal.org%2F

https://www.sciencedirect.com/science/article/abs/pii/S0016508502619067

https://www.sciencedirect.com/science/article/pii/S0893395222032227

https://www.sciencedirect.com/science/article/abs/pii/S1047279707002177

Wriiten by Rutuja Adake

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