Understanding Fatty Liver Disease

The liver normally contains some fat. However, a fatty liver occurs when more than 10% of the liver's weight is made up of fat. Excess fat in the liver can lead to inflammation of the liver, which is most commonly indicated through a liver blood test called ALT (alanine aminotransferase). An inflamed liver from excess fat may be related to alcohol consumption (alcoholic fatty liver disease). However, non-alcoholic fatty liver disease (NAFLD) can occur even without alcohol abuse.

Symptoms

Most people with a fatty liver actually have no symptoms at all. If NAFLD progresses to the point of cirrhosis (liver failure), then symptoms such as yellowing of the skin (jaundice), fatigue, abdominal pain and unexpected weight loss may occur.

Fatty Liver Among South Asians

The majority of fatty liver in South Asians is not related to alcohol abuse, but due to the presence of the following conditions:

• Excess weight, particularly around the stomach
• High cholesterol (especially high triglycerides)
• Metabolic syndrome
• Prediabetes and diabetes

Having one or more of the above conditions and consuming excess alcohol can further worsen fatty liver.

Diagnosis

Fatty liver is most commonly diagnosed by a routine liver function test drawn from your blood. The alanine aminotransferase (ALT) is a specific marker for liver inflammation and is typically elevated in individuals with a fatty liver.

If your ALT test results are elevated, your doctor may order additional blood tests to check for other conditions including viral hepatitis. If the test results are normal, the physician may order an imaging study (ultrasound) of your liver.

If your liver test results are only mildly elevated, you may be asked to repeat the test in a few months after a trial of regular exercise, diet and alcohol restriction.

Treatment

The following lifestyle changes can help patients with fatty liver:

• Controlling diabetes
• Lowering cholesterol
• Restricting alcohol consumption
• Weight loss through proper nutrition and exercise

Cholesterol Medications

Although cholesterol medications like statin medications (such as Lipitor® or Zocor®) may also cause liver inflammation, there have been no studies to date that have shown taking cholesterol medications leads to worsening of fatty liver.

In fact, since high cholesterol may be an underlying cause of fatty liver, lowering your cholesterol by taking medications may improve this condition.

Since the risk of having a heart attack from high cholesterol is much greater than the risks of taking cholesterol medications, most physicians would recommend starting medications when appropriate.

Prevention

Maintaining an ideal weight, controlling cholesterol and blood sugar through healthy eating and regular exercise, and avoiding excessive alcohol consumption can lower a person's risk of developing fatty liver.

See your physician regularly for a fasting cholesterol and blood sugar test to monitor your risk of developing a fatty liver.