In the United States, fatty liver disease is a serious problem. In fact, it's so widespread that the American Liver Foundation estimates one in five Americans over age 20 have fatty liver disease.
The term fatty liver refers to the infiltration of fat cells into tissues throughout your body—most commonly in the liver, although other organs may be affected as well. Someone with fatty liver disease might be completely free of any symptoms or uncomfortable symptoms such as fatigue. Many people don't even realize they have fatty liver until their doctor tells them during an unrelated exam. Sometimes fatty liver is detected only after a blood test for bad cholesterol levels reveals elevated triglycerides—a product of fat breakdown and metabolism.
In addition to obesity, diabetes mellitus and high alcohol intake play a role in fatty liver disease. So do other metabolic conditions such as hypothyroidism, Cushing's syndrome, growth hormone deficiency, and Wilson's disease.
Diagnosing fatty liver can be challenging because blood tests are often normal. USPSTF recommends screening for fatty liver disease with a high-sensitivity or alternative test. Some symptoms of fatty liver may also overlap with symptoms of nonalcoholic fatty liver disease (NAFLD), which is associated with obesity, insulin resistance, and hypertriglyceridemia.
Symptoms that your doctor may consider when diagnosing fatty liver include:
Doctors diagnose fatty liver disease based on clinical symptoms, physical exams—including palpating the abdomen to look for abnormal enlargement of the liver—and a fatty liver blood test.
In addition, your doctor may order imaging tests such as an abdominal CT scan or an MRI to more precisely diagnose fatty liver disease and determine its severity. With an ultrasound, he or she also may be able to detect fatty buildup in the liver's cells—known as hepatic steatosis. In extreme cases of fatty infiltration, there can be inflammation of the liver (steatohepatitis)—with symptoms including fatigue, jaundice, and pain over the right side of the upper abdomen. Fatty infiltration of other organs may also produce symptoms. For example:
Diagnosing fatty infiltration is important because it helps determine if you need treatment for fatty liver disease or some other health problem that could affect your liver.
In fatty infiltration, the cells lining your liver become engorged with fat and may rupture. This cuts off blood flow to the liver—and can lead to scarring of fatty tissue (fibrosis)—or even cirrhosis, a condition that develops when healthy liver tissue is replaced by scar tissue. Cirrhosis is a last-stage condition that's life-threatening, associated with serious complications such as bleeding in the digestive tract and fluid retention throughout the body. Left untreated, fatty infiltration leads to fatty liver disease. As fatty infiltration worsens, you risk developing nonalcoholic steatohepatitis or cirrhosis.
Fatty Liver Disease Treatment
There are no FDA-approved medications for fatty liver disease treatment. While fatty infiltration is usually reversible when the underlying cause of fatty liver disease is addressed, fatty liver disease itself can't always be cured.
But sometimes fatty infiltration improves without any treatment at all—and fatty infiltration usually goes away entirely if weight loss can be achieved. Even if fatty liver disease symptoms aren't obvious, your doctor may recommend lifestyle changes, such as losing weight or limiting your intake of alcohol or calories to help you achieve a healthy weight. These are typically the first steps taken in treating fatty liver disease.
Some people with mild fatty infiltration may need no medications for fatty liver disease. However, doctors generally treat nonalcoholic steatohepatitis with medicines that suppress fat buildup and inflammation. Many of these drugs are used "off-label" because they are approved to treat other conditions.
Additionally, fatty liver disease treatment may include the following:
Avoiding fatty foods: Your doctor may recommend that you reduce your intake of fatty foods, particularly fatty meats, full-fat dairy products, and fried foods. This can help improve fatty infiltration—and also help with overall weight loss.
Limiting alcohol consumption: Drinking more than three servings of alcohol a day increases your risk of fatty liver disease. Your doctor may advise limiting your alcohol intake to one serving, or less if you wish. It's usually best to spread out alcoholic drinks over the course of a day instead of drinking them all at once. Limiting how much you drink not only helps prevent fatty infiltration but also reduces your risk of fatty infiltration as well as fatty liver disease symptoms.
Losing weight: This is an important part of fatty liver disease treatment. Although fatty infiltration isn't reversible completely, it usually goes away completely if you can lose enough weight to return to a healthy weight. (Even a loss of 7 percent of your body weight and keeping that weight off may improve fatty infiltration.) Losing just 5 to 10 percent of your body weight can help normalize insulin levels and decrease fat in the liver. It also reduces fatty infiltration and inflammation, which contributes to fatty liver disease symptoms such as fatigue, jaundice, and pain on the right side or upper abdomen.
Exercise: Your doctor will advise you about the types and amounts of exercise that would be best for your fatty liver disease treatment plan.
As you can see fatty infiltration causes fatty liver disease which causes fatty liver diseases symptoms. The first step to fatty liver disease treatment is recognizing fatty infiltration and addressing its underlying cause. For fatty infiltration, changes to diet and lifestyle are typically recommended as the first step in fatty liver disease treatment.