Fatty liver is caused by an accumulation of fat cells within your liver. There are two types of fatty liver disease, alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). According to the National Institute of Health, NAFLD is considered to be the most common chronic liver disease in the United States, affecting around 100 million Americans. There are many causes of NAFLD including diabetes, high cholesterol, an underlying liver disease, and some medications. It is estimated that 75% of people with Type 2 diabetes have a fatty liver.

Who is at risk?

Although fatty liver can be seen in patients of all shapes and sizes, risk factors include:

  • Females
  • Age > 50 years
  • Alcohol consumption of more than 2-3 drinks per day for men and more than 1-2 drinks per day for women
  • Obesity
  • High blood pressure
  • Diabetes
  • Non-African-Americans

How do you know if you have a fatty liver?

Most people are asymptomatic, meaning that they show no symptoms. Occasionally, people will experience pain in the right upper area of their abdomen. The majority of people who are diagnosed with fatty liver are diagnosed through an “incidental finding” on imaging, such as a CT scan or ultrasound. This means that it is seen on imaging, even if that may not have been the reason the imaging was originally ordered.

Another way people are diagnosed with fatty liver is through routine blood work. An elevation in liver numbers would prompt further investigation into the cause. At that time, an ultrasound or CT scan would likely be checked to evaluate for steatosis (fat) within the liver.

Once there is evidence of inflammation and fat of the liver, you are considered to have non-alcoholic steatohepatitis (NASH), which indicates that there is damage to the liver cells.

If you have NASH, it is important to evaluate the severity of the fat and also determine if there is any hardening or scarring of the liver. This can be done by checking a fibroscan, a type of ultrasound done just on your liver to help determine the extent of fat and give a number to the stiffening of the liver.

Why is this important?

If left untreated, fatty liver can lead to cirrhosis, complete scarring of the liver. If your liver is not functioning properly, it can affect all areas of your body including your heart and kidneys. Cirrhosis can increase your risk of liver cancer and may even eventually lead to death.

How is this treated?

The best way to treat any fatty liver disease is to find out what is causing it and fix that. Whether you have alcoholic fatty liver or non-alcoholic fatty liver, you should completely abstain from alcohol.

Lifestyle modifications are the best form of treatment. If you are overweight or obese, losing 5-10% of your body weight can help reverse changes caused by fatty liver. If your cholesterol is elevated, follow a low-fat diet. You may also want to talk to your doctor about starting cholesterol-lowering medications. If you are diabetic, make sure your blood sugars are well controlled.

Although there are currently no FDA approved medications to treat NAFLD or NASH, there are several clinical research studies currently being done and medications are expected to be available within the next few years. In the meantime, the best thing you can do for your body is to maintain a healthy lifestyle.