Impaired liver function that contributes to the collection of fat in one’s liver is known as fatty liver disease. Treatment for fatty liver disease is entirely dependent on its cause and the severity of its presentation. Individuals with severe symptoms are considered to be at an increased risk for cirrhosis of the liver and liver failure.
Fatty liver disease, also known as nonalcoholic fatty liver disease (NAFLD), develops when liver function becomes compromised. Normally, the liver is the main center for metabolizing fat, and when its ability to do so becomes limited fat will accumulate, impairing the organ's ability to function. There are a variety of presentations associated with NAFLD, from the most mild that do not cause complications to its severest form, known as cirrhosis, that presents with pronounced inflammation that can induce scarring and contribute to liver failure.
In order to diagnose fatty liver disease, an individual generally undergoes extensive diagnostic testing that includes imaging tests, such as a computerized tomography (CT) scan, and blood tests to evaluate the condition and functionality of the liver and check enzyme levels. In the presence of signs indicative of fat accumulation, a liver tissue test may be performed to assess the extent of fatty buildup, inflammation and damage. A sample of the liver is obtained through a needle biopsy and sent for laboratory analysis to confirm a diagnosis.
Sometimes referred to as nonalcoholic steatohepatitis (NASH), individuals with fatty liver disease often remain asymptomatic, meaning they exhibit no symptoms at all. Those who do become symptomatic may present with mild signs that include fatigue, abdominal discomfort and unintended weight loss. Despite the vagueness of symptom presentation, the presence of pronounced inflammation and scarring over time can contribute to severe liver damage that ultimately jeopardizes organ function and leads to cirrhosis of the liver.
Presenting with more complex symptoms, cirrhosis of the liver is a serious medical condition that requires appropriate, proactive treatment. Individuals with cirrhosis will often develop symptoms that include abdominal distention and tenderness, stool discoloration and jaundice. Frequently associated with the presence of alcoholic fatty liver, individuals diagnosed with cirrhosis are encouraged to quit any and all alcohol consumption and to adopt a healthy diet that is low in sodium. Considered an irreversible condition, treatment for cirrhosis is centered on slowing the disease's progression and preventing the onset of further complications, such as infection and liver failure.
There is no established treatment for fatty liver disease other than the implementation of lifestyle and dietary changes. Individuals whose condition may have been caused by the regular use of certain medications may have their doses altered or prescription changed. In most cases, lifestyle and dietary changes, such as losing weight, getting appropriate exercise and adopting healthy eating habits, prove beneficial for alleviating symptoms and improving liver function in those with fatty liver disease.
Fatty liver can be classified as alcohol and nonalcohol related. Alcohol is a direct toxin to the liver and can cause inflammation. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic related steatohepatitis (NASH) are markedly different illnesses and there are many potential causes that are linked to fat accumulation in the liver.
Some of the causes of fatty liver include:
Diet: Consumption of excess calories in the diet (the excess caloric intake overwhelms the liver's ability to metabolize fat in a normal fashion, which results in fat accumulation in the liver).
Diseases: Fatty liver is also associated with type II diabetes, obesity, and high triglyceride levels in the blood, celiac disease, and Wilson's disease (abnormality of copper metabolism).
Medical conditions: Rapid weight loss and malnutrition.
Medications: Medications such as tamoxifen, amiodarone injection, amiodarone oral, and methotrexate are associated with NAFLD.
There is evidence to suggest the presence of an association between insulin resistance and the development of NAFLD. In this situation, although the body makes adequate insulin, the ability of cells to adequately use that insulin to metabolize glucose is abnormal. The relative excess of glucose is then stored as fat and can accumulate in the liver.
Fatty liver disease is often silent, producing no symptoms, especially in the beginning. If the disease advances -- which is usually over a period of years, or even decades -- it can cause:
Fatigue
Weight loss or loss of appetite
Weakness
Nausea
Confusion, impaired judgment, or trouble concentrating
These symptoms may also be present:
Pain in the center or right upper part of the abdomen
An enlarged liver
Patchy, dark skin discoloration, usually on the neck or underarm area
With alcoholic liver disease, symptoms may worsen after periods of heavy drinking. With NAFLD, the disease process can stop or reverse, or it may worsen. If cirrhosis develops, the liver loses its ability to function. This can cause signs and symptoms such as:
Fluid retention
Muscle wasting
Internal bleeding
Jaundice (yellowing of skin and eyes)
Liver failure
There is no specific treatment at this time for fatty liver disease. However, getting treatment for any underlying disease, such as diabetes, is essential. And you can take other steps to improve your condition.
If you have alcoholic liver disease and you are a heavy drinker, quitting drinking is the most important thing you can do. Find the support you need to be successful. With ALD, continued use of alcohol can lead to advanced disease, including alcoholic hepatitis or cirrhosis. Even for those with NAFLD, however, avoiding alcohol may help.
If you are overweight or obese, do what you can to gradually lose weight. A recent study showed that weight loss of at least 9% over a period of months can help reverse NASH. Even less weight loss than this can help lessen buildup of fat in the liver.
Eat a balanced and healthy diet and increase your physical activity. In addition to limiting calories, avoid diets rich in refined, rapidly digested carbohydrates. This includes limiting foods such as white bread, white rice, and concentrated sugar.
Avoiding unnecessary medications can also help slow or reverse the disease. Clinical trials are also looking at the effectiveness of certain antioxidants and newer diabetes medications in treating fatty liver disease. This is because of the disease's link to oxidative stress and diabetes. These include:
Vitamin E
Selenium
Betaine
Metformin
Rosiglitazone
Pioglitazone
New findings about the role of bacteria in the development of fatty liver disease may lead to still other options for treatment, such as by counteracting unbalanced diets with probiotics. These are dietary supplements containing healthy live bacteria or yeasts.
If cirrhosis becomes severe, a liver transplant may be needed. A surgeon removes the damaged liver and replaces it with a healthy one.