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Can I get Fatty Liver Disease even if I don’t consume alcohol? What lifestyle changes do I need to make?

Non-Alcoholic Steatohepatitis (NASH) can damage the liver cells and cause a number of changes in the organ. This can lead to liver fibrosis or destruction of liver cells. NASH can lead to further cirrhosis, says surgical gastroenterologist Dr Avinash Supe, Director, Hinduja Hospital

Nowadays, abdominal sonography in many patients shows an increase in liver fat and is reported as fatty liver disease with different grades.

What is Fatty Liver Disease?

Fatty liver disease is a common condition caused by the storage of extra fat in the liver. The liver is the largest organ in your body, which helps your body digest food, store energy and remove toxins before ingredients are assimilated in the body. When we eat more sugar or fatty food than what we need, our body stores this excess sugar or fat in the form of deposits in the liver.

Nowadays, abdominal sonography in many patients shows an increase in liver fat and is reported as fatty liver disease with different grades. Most people have no symptoms, and it doesn’t cause serious problems for them. However, in some cases, though, it can lead to liver damage. One can often prevent or even reverse fatty liver disease with lifestyle changes.

Why does it happen to even non-drinkers?

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Yes, it is possible to develop Fatty Liver Disease if even one is a non-drinker. It is called Non-Alcoholic Fatty Liver Disease (NAFLD)—a spectrum of disease characterised by hepatic steatosis in the absence of excessive alcohol consumption. Until a few years ago, life was relaxed. Over the last few decades, life has become more stressful and the effects of these lifestyle changes are visible to us in the form of fat in the liver. Non-alcoholic fatty liver disease affects about 25 per cent of the world’s population. In the United States, obesity, Type 2 diabetes and high cholesterol are on the rise, as is the number of patients with NAFLD. In India, too, the proportion is growing rapidly.

NAFLD can be subdivided into two categories — Simple fatty liver disease, in which fat in your liver does not damage your liver cells. The second is Non-Alcoholic Steatohepatitis (NASH), which involves damage to the liver cells and causes a number of changes in the organ. This can lead to liver fibrosis or destruction of liver cells. NASH can lead to further cirrhosis or liver cancer.

How is NAFLD different from Alcoholic Fatty Liver Disease?

Alcoholic fatty liver disease is caused by excessive alcohol consumption. Your liver processes alcohol and removes it from your body. The energy produced by alcohol is stored in the liver in the form of fat. But doing so produces harmful substances. These substances damage the liver cells. This also weakens your body’s natural immune system. The more you drink, the more your liver deteriorates. Alcoholic fatty liver disease (liver fat) is an early stage of alcoholic liver disease. The next stages are alcoholic hepatitis and cirrhosis.

What are the causes behind Fatty Liver Disease?

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When the fat in your diet is not properly digested or used properly, it accumulates in the liver. This is due to too much sugar or fat in the diet and less exercise/movement. Obesity, diabetes, thyroid/other endocrine deficiencies, gastric bypass surgery and high blood cholesterol/triglyceride levels increase the amount of fat in the liver.

Who is at risk of Fatty Liver Disease?

People with the following disorders/profile are more likely to develop fatty liver disease.

• Diabetes
• Obesity
• Middle-aged or elderly
• High levels of fat in the blood, such as cholesterol and triglycerides
• High blood pressure
• Corticosteroids and some cancer drugs
• Metabolic syndrome and metabolic disorders
• Rapid weight loss
• Diseases like Hepatitis C.

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Alcoholic fatty liver disease only occurs in people who drink heavily, especially those who have been drinking for a long time. Women who drink heavily, are more likely to be obese or have some genetic mutations can suffer from Fatty Liver Disease.

What are the symptoms of Fatty Liver Disease?

Fatty Liver Disease is graded in four grades. Grade 1 is a minor with minimal or no changes in liver parenchyma. Grade 4 means severe damage to the liver. Most people have a grade 1 disease. Fatty Liver Disease (Early Illness, Grade 1) does not cause any problems and has no symptoms. But some people may feel tired or have a mild inflammation in the upper right side of their abdomen. But if the disease is severe, the liver may become enlarged, swollen and jaundiced.

Some tests help you diagnose Fatty Liver Disease. These include sonography, blood tests , elastography, and sometimes biopsy. Diagnosis of increased fat is made by examination such as ultrasonography, CT scan or MRI. Blood detects the presence of jaundice.

ALT, AST, GGT enzymes should be tested in the blood and higher tests indicate presence of liver damage. Care should be taken only if the enzymes in the blood are increased due to fat in the liver. If the liver enlargement persists, a biopsy should be performed. Some of the enzymes in the blood (GGT) are increased if the fat in the liver causes the destruction of the liver cells. Destruction of liver cells can cause the liver to become firmer and stiff. Liver stiffness can mean fibrosis. It can later transform into cirrhosis.

What are the treatments for Fatty Liver Disease?

Weight loss is recommended for non-alcoholic fatty liver. Losing weight can reduce fat, inflammation and fibrosis in the liver. Some medications can increase fat in the liver, so these can be stopped on the doctor’s advice. Some diabetes medications and vitamin E can help reduce fat in the liver.

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The most important part of treating alcohol-related liver fat disease is to stop drinking. Cirrhosis can be caused by either alcoholic Fatty Liver Disease or Non-Alcoholic Fatty Liver disease (non-alcoholic steatohepatitis). Health problems caused by cirrhosis can be treated with medication, surgery and other medical procedures. If cirrhosis causes liver failure, you may need a liver transplant.

Are lifestyle changes needed to prevent Fatty Liver Disease?

Although Fatty Liver Disease is common these days because of changing lifestyle and food habits, the good news is that it can be controlled and reversed in most cases with lifestyle modifications, exercises and diet control. However few patients may have progression to cirrhosis and may require major therapy such as liver transplantation

TIPS FOR LIVER HEALTH

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o Eat a balanced diet, limit salt and sugar, and eat plenty of fruits and vegetables.
o Abstain from heavy alcohol consumption. Heavy alcohol use is associated with disease progression
o Vaccinate for hepatitis A and B, flu and pneumococcal disease. If you have hepatitis A or B with a Fatty Liver Disease, you are more likely to have liver failure.
o Weight management is essential. Exercise regularly, which will help you lose weight and reduce liver fat. Bariatric surgery and medications have also been useful in extremely obese individuals.
o Talk to your doctor before taking vitamins, or any supplements or alternative medications or specific diets.

Why him: Dr Avinash Supe, a renowned surgical gastroenterologist, was the former dean of Mumbai’s biggest civic-run hospital, King Edward Memorial (KEM) Hospital. He was the past president of the Indian Association of Surgical Gastroenterology. He is a recipient of the prestigious Dr BC Roy award. Currently, he is the director of Hinduja Hospital. He also heads the state’s death committee of Covid-19.

First published on: 02-09-2022 at 13:32 IST
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