Non-Alcoholic Fatty Liver (English)

Where is liver located?

Liver is located on the right side of your body in the upper right abdomen below your ribcage.

Why liver is important for the body?

Liver performs more than 500 vital functions. Few of them are as follows:

• Metabolism: It metabolizes sugar and stores them as glycogen. It also produces bile, albumin, cholesterol and amino acids.
• Storage: The liver stores significant amount of vitamins A, D, E, K, and B12, as well as iron and copper.
• Filters Blood and regulates blood clotting factors: Liver has important role in clearing the blood. It also regulates blood clotting factors.
• Immunity: It resist infections by making immune factors and removing bacteria from the bloodstream.

What are the common liver diseases?

Common liver diseases are:

• Fatty liver disease
  • Alcoholic Fatty liver disease
  • Non-alcoholic Fatty liver disease
• Diseases caused by chronic infection of Hepatitis B or/and Hepatitis C
• Other auto-immune diseases

What is fatty liver disease?

Fatty liver disease (steatosis) is a common condition caused by having too much fat build up in the liver. A healthy liver contains a small amount of fat. It becomes a problem when fat content exceeds 5% to 10% of the liver's weight.

How common is fatty liver disease in India?

1 in 4 adults have Fatty liver disease in India

Who are at risk of fatty liver disease?

Common risk factors of fatty liver disease are:

• Diabetes
• Overweight/Obesity
• Hypertension
• Dyslipidemia
• Metabolic syndrome (any 3 condition of the following list: insulin resistance/diabetes, high blood pressure, abdominal obesity, high triglyceride levels and low HDL-cholesterol).
• Excessive alcohol consumption
• Genetic factors
• Unhealthy diet
• Sedentary Lifestyle

What are the Symptoms of Fatty liver disease?

Most people don't have any symptoms in early stages. But some people may have following symptoms:

• Abdominal Pain
• Excessive Fatigue
• Loss of appetite
• Nausea

Since it is asymptomatic, how can we know that we have fatty liver disease?

One should get screened for fatty liver disease if risk factors such as obesity, diabetes, and others listed below, are present.

How can we get screened for fatty liver disease?

Screening of liver can be done through following methods:

• Blood tests such as Liver function test
• Scanning of liver using
  • Fibroscan
  • Ultrasound
  • CT-Scan

Who should get screened?

Adults having following should get screened:

• Diabetes
• Overweight/Obesity
• Metabolic syndrome
• Excessive Alcohol consumption
• Chronic infection of Hepatitis B and C
• Any symptoms of fatty liver disease

Is fatty liver dangerous?

In most cases, fatty liver disease doesn't cause any serious problems or prevent your liver from functioning normally. But for 7% to 30% of people with the condition, fatty liver disease gets worse over time. It progresses through three stages:

• The liver can become inflamed (swollen), which damages its tissue. This stage is called steatohepatitis.
• Scar tissue are formed where the liver is damaged. This process is called fibrosis.
• Extensive scar tissue replaces healthy tissue. This is called cirrhosis of the liver. Cirrhosis can lead to liver failure and liver cancer.

Should the fatty liver be ignored?

Though the fatty liver is asymptomatic, it should not be ignored. Ignoring the fatty liver can lead to liver damage and can cause cirrhosis in later stages.

Is fatty liver reversible?

Fatty liver is reversible in early stages.  Fatty liver is reversible by reducing weight and maintaining a healthy lifestyle.

How is fatty liver disease treated?

There are some medications for fatty liver disease, but this is an individualized management. Focusing on controlling the factors that contributed to the fatty liver disease is important. It is recommended to make lifestyle changes that can significantly improve the health. Treatment includes:

• Avoiding alcohol
• Losing weight.
• Taking doctor-prescribed medications to control diabetes, cholesterol and triglycerides (fat in the blood).

Are there medicines available to treat fatty liver disease?

Yes, some medicines may be used in selected patients, especially when fatty liver is associated with inflammation, diabetes, obesity, or high cholesterol. However, not everyone with fatty liver needs medicines.

Medicines that may be used include:

• Vitamin E
  • May be prescribed in non-diabetic patients with fatty liver and liver inflammation
  • Can help reduce liver inflammation in some patients
• Saroglitazar
  • A medicine that improves fat and sugar metabolism
  • May reduce liver fat and improve liver blood tests in selected patients
• Resmetirom
  • A newer medicine that helps the liver process fat more effectively
  • Shown to improve liver fat and scarring in patients with fatty liver with inflammation (MASH)
• Semaglutide and Tirzepatide
  • Medicines used for diabetes and weight loss
  • Cause significant weight reduction, which improves fatty liver

How can fatty liver disease be prevented?

The best way to prevent fatty liver disease is to do things to maintain overall health:

• Maintain healthy weight. Overweight or obese, should lose weight gradually.
• Consume a healthy diet
• Exercise regularly.
• Limit /Avoid alcohol consumption.
• Take medications as prescribed.

What should be done if I have fatty liver disease?

• Reduce weight
• Eat healthy food such as green leafy vegetables, fruits, salads, high fiber diet
• Perform physical exercise
• Avoid alcohol
• Avoid fatty food or food rich in fat.

What should be the ideal weight?

• Ideal of weight of males should be: (Height in cm - 100) kg
• Ideal weight of females should be: 5% less (Height in cm - 100) kg

How to maintain healthy diet?

Healthy diet can be maintained by consuming following:

• Intake of sufficient green vegetables.
• Consumption of seasonal fruits
• High fiber content food such as whole grains, oats, salad etc.
• Intake sufficient water (at least 2-3 liters per day)
• Maintain a gap of 3 hours between dinner and sleeping
• Avoid fatty food and items prepared using maida.
• Avoid alcohol and tobacco

What can be done in physical exercise?

Following physical activities can be undertaken:

• Jogging and Running
• Skipping
• Cycling
• Swimming
• Dancing and aerobic exercises
• Yoga and other physical exercises
• Brisk walking
• Combination of above-mentioned activities

What is known as 'brisk walking'?

Brisk walking means walking at the speed of at least 5.5km per hour for the people who don't exercise regularly.

References:

• EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)
  https://www.journal-of-hepatology.eu/article/S0168-8278(24)00329-5/fulltext
• AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease
  https://journals.lww.com/hep/Fulltext/2023/05000/AASLD_Practice_Guidance_on_the_clinical_assessment.31.aspx
• The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease
  https://link.springer.com/article/10.1007/s12072-024-10774-3