Alcohol abuse is not the only factor that can lead to fatty liver disease. Americans' gluttonous diets are also leading to another form called non-alcoholic fatty liver disease, which is just as damaging. Dr. Thomas W. Faust, a gastroenterologist at MedStar Franklin Square Medical Center, discusses the differences between the two forms of the disease.
What is fatty liver disease?
The liver is an important organ that controls protein, fat, and sugar metabolism. Additionally, the liver metabolizes medications that are consumed, and makes bile that helps digest food. When too much fat enters relative to the amount that leaves the liver, patients can accumulate abnormal amounts of fat in the liver. Fatty liver disease causes significant medical problems for patients in the United States and is expected to remain an important cause of illness and death for patients in the foreseeable future. Patients with fatty liver can develop scarring of the liver, which is called cirrhosis. Cirrhosis can lead to liver failure with associated complications or result in the development of liver cancer.
Non-alcoholic fatty liver disease is seen in patients who do not ingest significant quantities of alcohol. Typically, patients with this form of the disease have metabolic syndrome, which is associated with type 2 diabetes, hypertension, high cholesterol or triglycerides (a condition known as dyslipidemia), and excessive weight especially around the mid section.This form of liver disease is an important cause of liver failure and one of the leading indications for liver transplantation in the United States. It is expected to become the leading indication for liver transplantation over the next five to 10 years. Non-alcoholic fatty liver disease can be subdivided into non-alcoholic fatty liver and non-alcoholic steatohepatitis, or liver inflammation and damage caused by fat build-up. Patients with the latter condition are more susceptible to advanced liver disease and liver cancer.
What are the symptoms and signs of fatty liver disease?
Patients with fatty liver can present in different ways. Many patients do not have symptoms and fatty liver is found when abnormal liver blood tests are detected on a routine appointment with a clinician. Patients with alcoholic fatty liver and non-alcoholic fatty liver disease may present in different ways.
Patients with alcoholic fatty liver may present with mild discomfort in the abdomen after prolonged excessive alcohol use or binge drinking. Others may present with fever and right upper abdominal pain that suggest alcohol-induced inflammation or hepatitis. Moreover, patients can present with advanced liver disease associated with jaundice (yellowing of the skin and eyes), accumulation of fluid in the abdomen, confusion, bleeding in the gastrointestinal tract from varices (enlarged veins in the esophagus and stomach), and/or kidney failure. Furthermore, patients with advanced alcoholic fatty liver disease can develop liver cancer that is called hepatocellular carcinoma. Patients with liver cancer may be asymptomatic or present with a variety of findings including but not limited to pain in the right upper abdomen, loss of appetite, jaundice, weight loss, or liver failure.
Like alcohol-related fatty liver, patients with non-alcoholic fatty liver disease can be asymptomatic and may be identified through abnormal liver blood tests. Other patients may have evidence of jaundice, ascites, encephalopathy, or gastrointestinal bleeding. As with alcohol, non-alcoholic fatty liver disease is associated with development of liver cancer. Patients with non-alcoholic fatty liver disease may have, or are at risk for other significant medical problems such as heart disease, stroke, and non-liver related cancers. Studies have suggested that patients with non-alcoholic fatty liver disease may be at higher risk for development of cancers of the esophagus, stomach, colon, pancreas, kidney, and breast.
Who is at risk for getting fatty liver disease?
Women who drink alcohol appear to be more susceptible than men to disease progression. Patients with cirrhosis are at risk for liver failure with associated complications and liver cancer. Additionally, patients with alcohol-related liver disease frequently have other liver diseases such as hepatitis C, hepatitis B, or non-alcoholic fatty liver disease that increase the risk for disease progression.
Risk factors for non-alcoholic fatty liver disease are also becoming more problematic in the adolescent population. Clinical studies are conflicting but men may be more susceptible to non-alcoholic fatty liver disease progression when compared to women.
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The most important treatment for patients with alcoholic fatty liver, hepatitis, or cirrhosis is the discontinuation of alcohol. A multidisciplinary approach that includes primary care, liver specialists, psychiatrists, social workers, and rehabilitation counselors yields the best results. Patients with alcoholic liver disease may require medications in combination with counseling as part of their treatment program. Abstaining from alcohol can lead to regression of inflammation and scarring with improvement in liver function.Patients who are being considered for transplantation require intensive evaluation before and after surgery to ensure cessation of alcohol and prevention of relapse to drinking.
Patients with a non-alcoholic form of the disease will require strict control of metabolic syndrome risk factors. Normalization of blood sugar, blood pressure, cholesterol, and triglycerides in combination with weight control can lead to resolution of fatty liver, liver inflammation and regression of fibrosis. For overweight patients, a 5 to 10 percent reduction in current body weight, no more than 1- to 1.5 pounds per week, is recommended. Additionally, increased aerobic activity such as walking, cycling, swimming or jogging should be considered with modification of risk factors above.
Patients with either forms of the disease who have cirrhosis will require imaging of the liver every six months to screen for liver cancer. Furthermore, all patients with chronic liver disease should be checked for hepatitis A, hepatitis B, and hepatitis C. Vaccination is recommended for hepatitis A and B if not immune. Additionally, all patients should undergo endoscopy to screen for varices. Endoscopy utilizes a lighted flexible instrument to inspect the esophagus and stomach under sedation.