Fatty Liver Disease is a Major Health Concern
Health Watch: Fatty Liver Disease is a growing concern
By Brent D. Lemberg, MD • Special to The Journal • June 5, 2008
Most Americans are aware that alcoholism and hepatitis C can lead to cirrhosis of the liver, but few people understand the risk of cirrhosis from fatty liver disease. An estimated 20 to 30 percent of all Americans have some degree of fatty liver disease, making it the most prevalent liver disease in this country.
Who is at risk?
Fatty liver disease is most common in people who are obese or who have the metabolic syndrome, which comprises a group of conditions including obesity, diabetes and high cholesterol. Ninety percent of all obese patients have fatty liver disease, as do 50 percent of all diabetics.
What causes this disease?
Normally, the liver helps to break down, process and remove fat, cholesterol and lipids from the body. However, when a person becomes overweight and/or develops insulin resistance, the liver becomes less efficient and begins to store fat rather than breaking it down. Stored fat in the liver can lead to inflammation, which in turn can cause permanent scarring and cirrhosis.
How serious is this problem?
While the majority of cases of fatty liver disease are fairly benign, about 30 percent of the time, fatty liver disease advances to a more serious condition known as nonalcoholic steatohepatitis (NASH). Of those, 10 percent develop cirrhosis. The number of people facing the risk of cirrhosis is increasing as the incidence of obesity rises in this country. The Centers for Disease Control (CDC) predict that by the year 2025, nearly 40 percent of Americans will be obese, including 20-30 percent of American children. This poses a very significant health problem in this country.
Cirrhosis of the liver
Cirrhosis is one of the top ten causes of death by disease in this country. It results from permanent scarring of the liver, caused by chronic disease or damage. A scarred liver cannot function properly and is no longer able to filter toxins from the blood or produce important enzymes and clotting factors. Cirrhosis puts you at risk for liver failure and may require a liver transplant.
How is it detected?
Because there are often no specific symptoms, fatty liver disease is usually detected when a routine blood chemistry profile shows elevated liver enzymes. In determining the cause of a person’s elevated liver function, we check for risk factors for other reasons for liver disease such as viral hepatitis, autoimmune diseases, and medication-induced liver disease. A person in the latter stages of fatty liver disease may have pain in the right upper quadrant of his or her abdomen, and may experience fatigue. After ruling out other causes of liver disease, the doctor may order an ultrasound, CT scan, or MRI to look for signs of fat in the liver. A liver biopsy is rarely necessary to diagnose fatty liver disease, as long as other causes have been ruled out.
There is no quick fix. The optimal treatment is to lose weight, control diabetes, and lower your cholesterol. Losing 10 percent of your body weight is often enough to return liver function back to normal. There is ongoing research for medications to treat fatty liver disease, and there is some interest in the role of antioxidants, such as vitamins A and C.
However, at this time, the best treatment is weight loss. We have seen dramatic improvement of fatty liver disease in severely obese patients who have successfully undergone weight-loss (bariatric) surgery, such as gastric bypass.
People can and do live for a long time with fatty liver disease if it does not progress to a serious condition. The very best strategy is prevention, which starts by setting a healthy example for our children.
Dr. Lemberg is board-certified in gastroenterology/hepatology and internal medicine. He is on the medical staff of Cayuga Medical Center and in practice with Gastroenterology Associates of Ithaca, where he can be reached at 272-5011.
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