You probably haven’t spent much time worrying about the accumulation of fat in your liver. But maybe you should.
Alcoholics often get a fatty liver on their way to more serious events such as cirrhosis and liver failure. But even people who don’t drink are vulnerable to fatty liver disease, and it can have the same effect–leading to cirrhosis and liver failure as well as increasing the risk of heart disease and diabetes.
Non-alcoholic fatty liver disease (NAFLD) has been increasing in this country and around the world. It’s prevalence among American adolescents has more than doubled over the last three decades. And the disease affected 8.5 percent of persons registered in the Veterans’ Administration system in 2011 compared to only 1 percent 10 years ago.
If you have excess fat in your liver, you probably don’t know it. A definitive diagnosis can be made only with a liver biopsy, which is too invasive for screening use. For patients with elevated liver enzymes, however, an ultrasound scan of the liver can give doctors a pretty good idea.
Although a fatty liver has no effect on your weight or waist line, most persons with non-alcoholic fatty liver disease are overweight. Many have abdominal obesity and the metabolic syndrome–often a precursor of type 2 diabetes. A study published in 2009 found that 70 percent of diabetes patients had a fatty liver.
One recent study published in the British Medical Journal [November, 2011] concluded that a diagnosis of NAFLD by itself did not increase the risk of death. However, if you have a fatty liver, you’re highly likely to have other medical conditions such as high cholesterol, hypertension and the metabolic syndrome that increase your risk of serious disorders and early death.
Obesity as Cause?
The increased incidence of non-alcoholic fatty liver disease–particularly among children and adolescents–is frequently linked to the obesity epidemic that has occurred during the same time period. Obesity-related NAFLD has become an increasingly common reason for liver transplantation.
The problem occurs when the liver, for some reason, has difficulty breaking down fats. This may be due to changes in levels of liver enzymes. These, in turn, may be caused by liver damage associated with alcohol, medications or toxins.
At first, this fatty buildup may cause no harm, and it’s believed that a large percentage of the population has some degree of fatty buildup.
In a small number of people, the fat causes an inflammatory reaction in the liver, impairing its ability to function properly. This is known as non-alcoholic steatohepatitis (NASH).
The next stage occurs when the inflammation causes scarring of the liver, known as cirrhosis. Cirrhosis is a well known consequence of alcohol abuse, but it is a common and life-threatening occurrence in non-drinkers or moderate drinkers as well.
According to one intriguing theory, non-alcoholic fatty liver can be attributed in part to changes in the bacterial flora of the intestines. One study found distinctly different flora in obese patients with non-alcoholic fatty liver disease compared to non-obese subjects.
NAFLD is completely reversible...but only if treated early enough. Unfortunately, there are few symptoms at this stage other than those of associated disorders such as diabetes and heart disease.
There is no specific medication now recommended as effective against NAFLD. The key is treating associated problems such as diabetes, the metabolic syndrome and high cholesterol while making meaningful changes in lifestyle.
WEIGHT LOSS is nearly always the first step. The American Association for the Study of Liver Disease recommends weight loss of 10 percent of body weight or greater.
Several studies have found weight loss to be effective in reducing or eliminating the inflammation caused by fatty liver disease. In one study of 50 patients [Hepatology, January, 2009], subjects taking orlistat, which decreases the body’s absorption of fat, showed no direct improvement but those losing at least 9 percent of body weight through dieting showed reversal of existing liver damage.
A BETTER DIET: Even those who have trouble losing weight can be successful in preventing or treating fatty liver disease through improvements in their diet.
Laboratory studies have found that mice fed diets high in easy-to-digest carbohydrates such as white bread, white rice, concentrated sugar or even some ready-to-eat breakfast cereals are quicker to develop excess fat in the liver than mice fed low glycemic index carbs such as whole grains and brown rice.
EXERCISE is recommended–for weight control and for management of associated problems such as diabetes, high cholesterol and high blood pressure. Aim for at least 30 minutes a day of moderate or vigorous physical activity.
DRINK WINE, COFFEE: Because fatty liver and cirrhosis are common problems faced by alcoholics, the traditional advice for persons with non-alcoholic fatty liver is to avoid alcohol altogether. But at least one study found that persons who reported drinking up to one glass of wine a day had half the risk of NAFLD as those drinking no alcoholic beverages. This benefit did not apply to subjects drinking other alcoholic beverages. In fact, those drinking 12 ounces of beer or 1 ounce of liquor had a four-fold increased risk.
Coffee drinkers also seem to have a reduced risk. A large population study in Norway found coffee consumption associated with a lower risk of liver cirrhosis. And in the United States, data from the first National Health and Nutrition Examination Survey (1971-1975) found that those regularly drinking coffee or tea had a reduced risk of dying from or being hospitalized for severe chronic liver disease.
BE WARY OF DRUGS: You can protect your liver by avoiding unnecessary use of over-the-counter or prescription medications. Drugs associated with an increased risk of NAFLD include amiodarine, methotrexate, tamoxifen and HAART.
Whether as a cause or an effect, excess fat in the liver is associated with some serious, even life threatening, medical conditions. Fatty liver affects a significant and growing portion of the population; if you’re one of them, it’s time to start taking action.
REFERENCES:
William F. Balistreri, “Fatty liver takes center stage,” Digestive Disease Week, 2013, Medscape Gastroenterology, 2013.
A. Birerdinc, et al, “Caffeine is protective in patients with non-alcoholic fatty liver disease,” Aliment Pharmacol Ther, 2012;35(1):76-82.
Will Boggs, M.D., “Nonalcoholic fatty liver disease on the rise in US adolescents,” Reuters Health, November 9, 2012 (Journal of Pediatrics, 2012).
“Fatty liver disease,” WebMD Hepatitis Health Center, Reviewed by Michael Saenger, M.D., on June 6, 2012.
D. Festi, et al, “Review article: the diagnosis of non-alcohol fatty liver disease,” Aliment Pharmacol Ther, 2013;37(4):392-400.
Anuradhani Kasturiratne, “Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus,” Journal of Gastroenterology and Hepatology, 2013;28(1):142-147.
Daniel M. Keller, Ph.D., “Fatty liver predicts heart risk independent of other factors,” Medscape Medical News, May 16, 2013 (International Liver Congress 2013; 48th Annual Meeting of the European Association for the Study of the Liver, Abstract 1356, presented April 26, 2013.
Jacob M. Kneeman, “Secondary causes of nonalcoholic fatty liver disease,” Therapeutic Advances in Gastroenterology, 2012;5(3):199-207.
January W. Payne, “Nonalcoholic fatty liver disease: 5 tips for treatment, prevention,” Health, April 10, 2009.
Mark M.Smits, et al, “Non-alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome,” Journal of Gastroenterology and Hepatology, 2013;28(4):664-670.
Norbert Stefan, “the metabolically benign and malignant fatty liver,” Diabetes, 2011;60(8):2011-2017.
08/19/2013
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