How Healthy is My Liver? Your Guide to Fatty Liver Disease

Metabolic dysfunction-associated steatotic liver diastase (MASLD) was found to afflict 38.6% of adult Indians and 35.4% of youngsters. With the disease ‘epidemising’ the world, it crops up on routine exams more often than not with real symptoms, making it a silent offender that needs your attention early to prevent liver damage.

To put it simply, it is fat accumulation in the liver cells; the fat amount must exceed 5% of the liver weight. Excessive abnormal fat deposits initiate liver inflammation, leading to chronic liver disease worldwide. Also called hepatic (liver) steatosis (fat build-up in an organ),  MASLD occurs when no other reasons for secondary hepatic fat accumulation (e.g., excessive alcohol use) can be found. It is a relatively benign concern, while metabolic dysfunction associated steatohepatitis (MASH)) is the more severe form. Untreated, prolonged MASLD may lead to fibrosis and cirrhosis.

The different types of fatty liver disease are:

• The first type of NAFLD, also known as metabolic dysfunction-associated steatotic liver disease (MASLD), is linked to metabolic syndrome caused mainly by insulin resistance.
• The second type is associated with infectious pathologies like hepatitis C and HIV, medication, toxins, and inherited metabolic diseases.
• Alcoholic fatty liver disease (AFLD) is a condition resulting from prolonged excessive alcohol consumption

Apart from that, fatty liver disease is also staged or graded according to its progress:

• Fatty liver
• Fatty liver with inflammation 
• Fatty liver with fibrosis
• Fatty liver causing cirrhosis

A comparatively uncommon emergency during pregnancy, acute fatty liver of pregnancy (AFLP) is characterised by excessive fat accumulation in the liver. It usually appears in the third trimester and can jeopardise the health of both the mother and the baby.  The condition arises from abnormalities in fatty acid metabolism during the later stages of pregnancy, yet the precise reason remains unclear.

As we said, fatty liver disease appears, grows, and remains silent for a long time. However, with time and no active intervention, it can pose a serious health problem. Some of the implications of this condition are:

• Affected liver function: The liver is the seat for detoxification, protein synthesis, and digestion. A fatty liver may not perform all these actions efficiently. Poor appetite, frequent indigestion, nausea, etc., could indicate a problem.
• Diminished quality of life: A fatty liver may cut down on a variety of regular tasty treats and foods, like desserts and fried snacks, making life boring. Symptoms associated with fatty liver like appetite and digestive problems may also ruin the peace of having hearty meals. 
• Association with other health conditions: Fatty liver disease is linked with other metabolic disorders such as cardiovascular disease, obesity, and type 2 diabetes; thus, increasing overall health risks.
• May not resolve naturally and progress into complications: Lifestyle modifications such as reducing weight, following a healthy diet, and regular exercise can reverse early-stage fatty liver disease, but more serious stages might need medical treatment and not be completely reversible and may lead to a liver transplant.

The causes of fatty liver are so commonplace that the condition happens to run in most families.  Here are some of the causes of MASLD :

• Obesity and being overweight
• Malnourishment 
• Liver infections like hepatitis
• AIDS/HIV 
• High cholesterol levels in the blood
• Resistance to insulin, like in type 2 diabetes
• Polycystic ovary syndrome (PCOS)
• Sleep apnea

Underactive thyroid glands and pituitary glands can also lead to fatty liver disease.MASLD  may be an incidental finding in routine body checks. However, it can show symptoms. The symptoms of fatty liver disease may be subtle and often absent in early  stages. Nonetheless, common symptoms may include tiredness, discomfort in the right upper part of the abdomen, nausea, loss of weight, and a yellow tint to the skin (jaundice).

To mitigate the risk factors associated with fatty liver disease, early diagnosis and reducing their likelihood is the optimal approach. A comprehensive history, thorough physical examination, and diagnostic methods such as imaging tests can assist in diagnosing fatty liver.

Fatty liver disease treatment includes lifestyle modifications like a healthy diet (less unhealthy fats, less sugar, and more fibre and proteins), regular exercise, and weight loss that can improve liver health. Controlling underlying conditions like obesity, diabetes, and high cholesterol, limiting alcohol consumption, and taking medications under the careful supervision of physicians are important to avoid risk factors for a fatty liver.

According to Dr Monteiro Grancy Vijayraj, consultant surgeon at St Joseph’s Mission Hospital, Mananthavady, “Fried foods and desserts/sweet munchies are the biggest culprits. Prioritise your liver health if you tend to carelessly binge every weekend.”

Fatty liver disease is a prevalent issue worldwide. Its undetectable nature and slow progression make the treatment for this condition quite underrated. What usually appears as a part of routine diagnostic tests should, in reality, be a proactive approach to mitigating its risk factors and preserving liver health. Learning about the causes, symptoms, and potential consequences of fatty liver disease is an important part of your journey to recovery.

Fatty liver disease is the accumulation of fat in the liver cells. The process starts with the accumulation of fat in the liver, which results in higher insulin resistance, along with changes at the cellular and molecular levels due to damage from cytokines, hyperinsulinemia, lipid peroxidation, alterations in the extracellular matrix, energy homeostasis, and the functioning of the immune system.

A fatty liver, though initially showing no symptoms, can eventually lead to signs such as tiredness, pain in the right upper abdomen, feelings of nausea, loss of weight, and a yellowish tint to the skin, known as jaundice.

The factors that contribute to the development of fatty liver include poor eating habits, obesity, type 2 diabetes, high cholesterol, PCOS, liver infections, HIV/HCV, etc. 

Fatty liver disease is diagnosed by healthcare professionals through various types of diagnostic and imaging investigations.

Lifestyle changes which you can make to manage fatty liver disease include a healthy diet (less unhealthy fats, less sugar, and more fibre and proteins), regular exercise, and weight loss.