Fatty liver in
general
According to Dr.
Eternity Labio, gastroenterologist and liver specialist, “Technically
speaking, fatty liver is the accumulation of fat in your liver. It is the
most common liver disease in the whole world. A third of the world’s
population has fatty liver; that’s how common it is. In the Philippines,
we don’t have the data yet. But I would say that anyone who presents with
diabetes, hypertension and hypercholesterolemia would be at risk for fatty
liver.”
Dr. Eternity Labio stresses the most effective way
to avoid fatty liver—lifestyle modification
There are two types of fatty liver says Dr. Labio: “The first type of fatty liver is commonly seen in people who drink alcohol, and it can also be due to certain medications that they take. But it’s the second type—nonalcoholic fatty liver disease (NAFLD)—we’re concerned about because of its association with obesity, high cholesterol and diabetes, or what we call metabolic syndrome. In fact, fatty liver is the hepatic manifestation of metabolic syndrome.”
Complications
The progression of fatty liver follows a spectrum of conditions that leads to serious complications. “The mildest form is simple fatty liver or steatosis, which is fat accumulation in the liver that usually causes no damage to the liver. If left unchecked, it may progress to a more serious form—nonalcoholic steatohepatitis or NASH, which is fat accumulation with inflammation. Both steatosis and NASH are reversible; but if allowed to progress, they may lead to life-threatening complications—cirrhosis or scarring of the liver and even liver cancer.”
Dr. Labio reveals that just a small fraction of patients could progress to complications. Lifestyle modification, however, can arrest the progression of fatty liver. “Among Filipinos especially, the more important problem is not fatty liver but hepatitis B, which is the leading cause of liver cancer. Since hepatitis B does not manifest signs and symptoms, it is a silent killer. The nationwide prevalence of hepatitis B is 16 percent. With our population at 78 million, we have an estimated 12 million Filipinos walking around with hepatitis B who are at risk of developing liver cancer. [Compared to hepatitis B,] the incidence of fatty-liver complications is very low. Out of all cases of fatty liver, only less than 10 percent would develop NASH, and only one percent of this number would develop cirrhosis from NASH. So it’s a very, very small proportion.”
Risk factors
The risk factors of fatty liver are the
signs and symptoms of metabolic syndrome, which is a cluster of disorders
that increases an individual’s risk of diabetes, heart disease and stroke.
These are:
• Overweight and obesity, especially
around the waist (abdominal obesity). Risk increases with every pound of
excess weight. More than 70 percent of patients with NASH are obese.
• Hypertension
• High levels
of cholesterol and triglycerides and very low levels of
high-density lipoprotein (HDL) cholesterol, or the “good” cholesterol, are
noted in up to 80 percent of patients with NASH
•
Diabetes. Patients with diabetes—either those with
insulin resistance or those whose pancreas don’t produce enough
insulin—are unable to maintain normal glucose levels, which may damage the
liver and other vital organs. Three in four patients with NASH also have
diabetes.
Other risk factors of fatty liver:
•
Abdominal surgeries such as small-bowel resection,
gastric or jejunal bypass, which lead to rapid weight loss, may increase
the risk for fatty liver.
• Certain medications
such as oral corticosteroids, synthetic estrogens for menopause, tamoxifen
and other medications for breast cancer, agents for heart arrhythmias, and
immunosuppressing drugs for rheumatoid arthritis.
• Other
medical conditions such as inherited metabolic disorders like
galactosemia or glycogen storage disease
Signs and symptoms
A patient with fatty liver usually does
not present with any signs and symptoms. If at all they develop, they’re
vague and nonspecific:
• Fatigue
• Malaise
•
Dull ache in the upper right abdomen (possible sign of liver
enlargement)
When a patient progresses to an advanced
stage, especially cirrhosis, they may present with:
• Lack of
appetite
• Weight loss
• Nausea
• Weakness
• Fatigue
• Loss of interest in sex
•
Appearance of small, red spider veins under the skin or easy
bruising
• Yellowing of the skin and eyes and dark, cola-colored
urine
• Bleeding from engorged veins in the esophagus or
intestines
• Itching in the hands and feet and eventually the
entire body
• Swelling of the legs and feet from retained fluid
(edema)
• Ascites
• Mental confusion, such as
forgetfulness or trouble concentrating (encephalopathy)
• Liver
failure
Diagnosis
According to Dr. Labio, “We usually get
patients with fatty liver because their diabetes or heart doctor referred
them to us after finding elevated levels of alanine aminotransferase (ALT)
in their blood test or the appearance of fatty liver on
ultrasound.”
The diagnosis of fatty liver is established through the
alcohol history of the patient, blood-sugar and cholesterol levels, and
elevated enzyme levels with the liver function test, especially ALT and
serum glutamic-pyruvic transaminase (SGPT). Imaging with ultrasound or CT
scan is also helpful.
Definitive diagnosis is achieved, however,
through liver biopsy, with the characteristic signet-ring appearance of
the liver cells (fat accumulation has pushed the nucleus of the hepatocyte
to the periphery).
Medical treatments
“My patients with fatty liver often ask
me ‘Is there a drug that I could take?’ Actually, despite the number of
researches being done, there is no wonder drug for fatty liver,” says Dr.
Labio. “There are many drugs that have been tested in clinical trials in
the U.S. and Europe, but no single drug has passed the test.”
Among the
medications currently under study are:
• Vitamins E and
C. These antioxidants may help reduce damage to the liver caused
by unstable oxygen molecules (oxidants) that destroy liver-cell
membranes.
• Ursodiol (Actigall). Used to treat
gallstones, it decreases bile-acid production, which may in turn help
lower the high levels of liver enzymes in patients with liver
disease.
• Diabetic medications like metformin
(Glucophage, Glucophage XR), pioglitazone (Actos), rosiglitazone (Avandia)
and betaine (Cystadane)
• Orlistat (Xenical).
Since the drug acts to block the absorption of fat from food, it may help
reduce the amount of fat in the
liver.
