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Fatty Liver

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a condition in which fat builds up in your liver. Two types of Nonalcoholic fatty liver disease (NAFLD) are “simple fatty liver” and “nonalcoholic steatohepatitis” (NASH).

“Simple fatty liver”, also called “nonalcoholic fatty liver” (NAFL), is a form of “Nonalcoholic fatty liver disease” (NAFLD) in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.

“Nonalcoholic steatohepatitis” (NASH) is a form of NAFLD in which you have inflammation and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of liver disease in the United States. Most people with Nonalcoholic fatty liver disease (NAFLD) have simple fatty liver. Only a small number of people with Nonalcoholic fatty liver disease (NAFLD0 have NASH. Experts estimate that about 20 percent of people with Nonalcoholic fatty liver disease (NAFLD) have NASH.

Between 30 and 40 percent of adults in the United States have Nonalcoholic fatty liver disease (NAFLD). About 3 to 12 percent of adults in the United States have NASH.

Risk Factor

Nonalcoholic fatty liver disease (NAFLD) is more common in people who have certain conditions, including obesity and conditions that may be related to obesity, such as type 2 diabetes. Researchers have found NAFLD in 40 to 80 percent of people who have type 2 diabetes and in 30 to 90 percent of people who are obese. In research that tested for NAFLD in people who were severely obese and undergoing bariatric surgery, more than 90 percent of the people studied had NAFLD.

Symptoms

Usually, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are silent diseases with few or no symptoms.

You may not have symptoms even if you develop cirrhosis due to NASH.

If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.

Diagnosis

Doctors use blood tests, imaging tests, and sometimes liver biopsy to diagnose NAFLD and NASH.

Blood test: You have NAFLD or NASH if your blood test shows increased levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Your doctor may perform additional blood tests to find out if you have other health conditions that may increase your liver enzyme levels.

Imaging tests:

Your doctor may use the following imaging tests to help diagnose NAFLD:

Ultrasound: Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create an image of their structure.

Computerized tomography (CT) scans: CT scans use a combination of x-rays and computer technology to create images of your liver. For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays.

Magnetic resonance imaging (MRI): MRI machines use radio waves and magnets to produce detailed images of your organs and soft tissues without using x-rays. Imaging tests can show fat in your liver. These tests can’t show inflammation or fibrosis, so your doctor can’t use these tests to find out whether you have simple fatty liver or NASH. If you have cirrhosis, imaging tests may show nodules, or lumps, on your liver.

Fibroscan (Elastography): Fibroscan (Elastography) is also called liver stiffness measurement, uses either ultrasound or MRI to measure the stiffness of the liver. Scar tissue increases the stiffness of the liver. Elastography can show how much scarring is present with some reliability.

Liver biopsy: During a liver biopsy, a doctor will take a piece of tissue from your liver. A pathologist will examine the tissue under a microscope to look for signs of damage or disease. A liver biopsy is the only way to detect liver inflammation and damage to diagnose NASH. Doctors don’t recommend this test for everyone with NAFLD. Your doctor may recommend a liver biopsy if you are more likely to have NASH or if your other tests show signs of advanced liver disease or cirrhosis.

Complications

The majority of people with NAFLD have simple fatty liver, and people with simple fatty liver typically don’t develop complications. NASH can lead to complications, such as cirrhosis and liver cancer. People with NASH have an increased chance of dying from liver-related causes.

If NASH leads to cirrhosis, and cirrhosis leads to liver failure, you may need a liver transplant to survive. Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease. Cardiovascular disease is the most common cause of death in people who have either form of NAFLD

Treatment

Weight loss

Weight loss is recommended to treat nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Weight loss can reduce fat in the liver; inflammation; and fibrosis, or scarring. If you are overweight or obese, losing weight by making healthy food choices, limiting portion sizes, and being physically active can improve NAFLD and NASH. Losing at least 3 to 5 percent of your body weight can reduce fat in the liver. You may need to lose up to 10 percent of your body weight to reduce liver inflammation.

Doctors recommend gradually losing 7 percent of your body weight or more over the course of 1 year.8 Rapid weight loss through very low calorie diets or fasting—eating and drinking nothing except water—can make NAFLD worse.

Medicines

No medicines have been approved to treat NAFLD and NASH. However, researchers are studying medicines that may improve these conditions.

Pioglitazone

Some studies suggest that pioglitazone (Actos), a medicine for type 2 diabetes, improves NASH in people who don’t have diabetes. Researchers need more information to find out whether this medicine is safe and effective for long-term use in people with NASH.A study by the National Institute of Diabetes and Digestive and Kidney Diseases found that treatment with vitamin E or pioglitazone improved NASH in about half of the people treated.

Vitamine E

Vitamin E may be recommended for people who have NASH and don’t have diabetes or cirrhosis. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can actually damage your liver.

If NASH leads to cirrhosis, you are advised to consult the expert for proper medical care. If cirrhosis leads to liver failure, you may need a liver transplant.

Prevention

Weight loss

You may be able to prevent NAFLD and NASH by eating a healthy diet, limiting your portion sizes, and maintaining a healthy weight.

If you don’t have nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), you may be able to prevent these conditions by eating a healthy diet, limiting your portion sizes, and maintaining a healthy weight.

Limiting your intake of fats to help prevent or treat NAFLD or NASH.

Fats are high in calories and increase your chance of becoming obese. Four types of fats are

Some studies suggest that pioglitazone (Actos), a medicine for type 2 diabetes, improves NASH in people who don’t have diabetes. Researchers need more information to find out whether this medicine is safe and effective for long-term use in people with NASH.A study by the National Institute of Diabetes and Digestive and Kidney Diseases found that treatment with vitamin E or pioglitazone improved NASH in about half of the people treated.

  •   saturated fats, found in meat, poultry skin, butter, lard, shortening, and all milk and dairy products except fat-free versions.
  •   trans fats, found in foods that list hydrogenated or partially hydrogenated oil on the label, such as crackers and snack foods, commercially baked goods such as cookies and cakes, and fried foods such as doughnuts and french fries.
  •   monounsaturated fats, found in olive, peanut, and canola oils.
  •   polyunsaturated fats, found in greatest amounts in corn, soybean, and safflower oils, and many types of nuts. Omega-3 fatty acids are a type of polyunsaturated fat. Sources include oily fish such as salmon, walnuts, and flaxseed oil.

Replacing saturated fats and trans fats in your diet with monounsaturated fats and polyunsaturated fats, especially omega-3 fatty acids, may reduce your chance of heart disease if you have NAFLD.

Diet

Dietary changes are advised to help treat NAFLD and NASH:

  •   Eat more low-glycemic index foods—such as most fruits, vegetables, and whole grains. These foods affect your blood glucose less than high-glycemic index foods, such as white bread, white rice, and potatoes.
  •   Avoid foods and drinks that contain large amounts of simple sugars, especially fructose. Fructose is found in sweetened soft drinks, sports drinks, sweetened tea, and juices.
  •   Avoid heavy alcohol use, which can damage your liver. For men, experts define heavy alcohol use as more than 4 drinks per day or more than 14 drinks per week. For women, heavy alcohol use is more than 3 drinks per day or more than 7 drinks per week.

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