Fatty Liver: The Silent Killer

Changes in the way people eat and live, such as the consumption of high fat foods and the lack of physical activity, have led to an increase in the number of patients with fatty liver. If left untreated, fatty liver can lead to more serious and potentially fatal conditions. The best way to control and reduce the risks of fatty liver are through lifestyle changes.

Situated on the upper right side of the abdomen just below the diaphragm, the liver is the body’s largest internal organ and performs many important functions. It helps food metabolism by converting carbohydrates into glucose for energy in the body and removes toxins produced during metabolism or introduced to the body from external sources. The liver also contributes to the innate immune system as well as producing proteins which provide essential nutrients for the body.

If the liver is exposed to viruses, bacteria, fungi, parasites, medications, alcohol, chemicals, toxins and excessive fat, it may suffer damage, including hepatitis, cirrhosis, liver cancer or fatty liver.

Fatty liver can be divided into 2 groups:

  • Alcoholic Fatty Liver Disease
  • Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver is directly caused by a diet that is high in fats, sugars or carbohydrates, which are then transformed by the body into liver triglycerides and accumulated as excess fat in the liver cells. This accumulation of fat in the liver cells is exacerbated by several factors, including obesity, diabetes, high blood cholesterol, viral hepatitis, certain medications and excess iron in the liver.

The main risk factors of fatty liver include the following:

  • Waist circumference larger than 40 inches in men and 35 inches in women
  • High blood sugar level (over 100 mg/dL.)
  • High triglyceride level (over 150 mg/dL.)
  • Low level of high-density lipoprotein or HDL cholesterol (With HDL cholesterol, higher levels are better. Ideally, HDL cholesterol should be above 40 mg/dL for men and above 50 mg/dL for women.)
  • High blood cholesterol

Generally, the progression of fatty liver is very gradual. It is a silent killer. Most patients experience no symptoms, leaving them unaware of their condition. They usually receive their diagnosis during their annual health check-up or when they consult a doctor for other problems. When the liver becomes inflamed, the patients feel exhausted easily.

About 10-20 percent of fatty liver patients develop hepatitis, which increases the risk of cirrhosis and liver cancer. It is therefore very important for fatty liver patients to take good care of their health.

The treatment of fatty liver depends on the stage of the condition. The treatment differs depending on whether or not there is any inflammation or scarring of the liver. The use of medication is subject to the doctor’s opinion, depending on each patient’s specific condition. Generally, the fatty liver condition can be reversed through lifestyle and diet changes. It is important to control the risk factors, including high blood cholesterol, diabetes and high blood pressure.

Lifestyle changes that can control and lower the risk of fatty liver:

  • Choose a healthy diet: Eat a healthy and well-proportioned diet. Eat more fruits and vegetables. Reduce carbohydrates, fats and sugars.
  • Lose weight and exercise: If a patient is overweight, losing weight is a good treatment of fatty liver. The amount of weight loss should be around 5-10% of the body weight in order to reduce the steatosis, and the above 10% to improve any inflammation. However, weight loss should be safe and gradual. Healthy weight loss is about 0.5-1 kilogram per week.
  • Get immunization against viral hepatitis: Patients with liver disease should check if they are immune to viral hepatitis. If not, consult your doctor for viral hepatitis vaccinations so as to prevent complications.
  • Have an annual check-up: Have a liver function test and check for other factors that may help detect the presence of fatty liver.

By Dr. Poungpen Sirisuwannatash, gastroenterologist and hepatologist, Digestive Disease Center, Bumrungrad Hospital

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