There are several gastrointestinal conditions like fatty liver and cystic lesion of pancreas which can predispose one to develop sinister lesion and eventually succumb to the condition. For this article, I will focus on the topic of fatty liver.
In this piece, I will give a broad overview of fatty liver condition as well as tips to mitigate potential problems arising from it. But before I go into the details of fatty liver, let us first understand the role of the liver.
The liver is one of the largest organs in our body. It is situated in the right upper abdomen, and performs many important functions, including the making of important blood proteins (albumin) and the regulation of blood clotting factors. Our liver also helps to detoxify blood toxins like alcohol, poison and drugs. It produces bile which helps in the digestion of food and waste removal. Besides bile, our liver also produces cholesterol and a special protein to carry fats throughout our body. It even acts as a store for important nutrients like vitamins and sugar. In short, the liver is a crucial organ that we depend on heavily for our daily survival.
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Fatty liver is a common liver disease worldwide. It is estimated that one in four adults affected by this condition attribute it to an affluent lifestyle. Yet, many people remain unaware about whether they have this condition. This is because the disease does not produce symptoms in its early and middle stages. However, once the disease advances, it can be life threatening.
Liver disease can be caused by many etiologies, including excessive alcohol use, certain drugs, and certain viral infections like Hepatitis B and C. However, it is more commonly associated with metabolic disease, also known as non-alcoholic fatty liver disease (NAFLD). In NAFLD, the fat buildup is related to metabolic complications of insulin resistance and obesity, both of which are risk factors for the disorder. Imagine your body fat tissues releasing excessive fat into your bloodstream, which then becomes available to your liver. At the same time, insulin resistance in your body will promote excess sugar in your liver to be stored as fat.
NAFLD is a spectrum of conditions. It can range from “simple fat” (non-alcoholic fatty liver; NAFL) to “bad fat” (non-alcoholic steatohepatitis; NASH), which is related to inflammation and liver damage (see Figure 1).
NASH occurs when there is a build-up of excessive fat in the liver, accompanied by inflammation and damage. It often occurs in people who are obese and have other metabolic diseases like diabetes mellitus and high cholesterol level. The problem arises when prolonged liver inflammation leads to scarring (fibrosis), which can accumulate over time and result in permanent scarring and hardening of the liver. This is known as liver cirrhosis. Over time, the accumulation of the damage can trigger the development of liver cancer.
INDIVIDUALS AT RISK
Individuals who are at risk of developing NAFLD include those with conditions that predispose them to metabolic syndrome. These include diabetes (insulin resistance state), hypertension, cholesterol problems, obesity (with BMI > 25kg/m2 ), and central obesity (waist circumference > 90cm in Asian man / >80cm in Asian women). Besides these, other associated conditions like obstructive sleep apnea (OSA), polycystic ovary syndrome (PCOS), underactive thyroid (hypothyroidism) as well as underactive pituitary (hypopituitary) may also result in the development of NAFLD.
NAFLD usually does not cause any symptoms. If symptoms are present, they may be non-specific symptoms like tiredness, bloatedness, nausea, loss of appetite and discomfort over the right upper abdomen. However, if the NAFLD/NASH progresses to cirrhosis, signs and symptoms of cirrhosis may appear.
NAFLD is diagnosed by a combination of consultation, physical examination, blood tests and imaging studies of the liver. These include liver blood tests, ultrasound, CT or MRI scans, which may show the fatty liver. Transient or MR elastography may also be used to assess the hardness of the liver and the presence of fatty liver. Other blood tests may be needed to predict the severity of disease or exclude other liver diseases. In certain situations, liver biopsy may be required to ascertain the seriousness of the case.
Many patients are curious about the treatments available for fatty liver disease. The key to the management of NAFLD is actually lifestyle modification. Clinical studies have shown that exercise with appropriate weight loss is the cornerstone for the management of NAFLD. Patients should aim for at least a 7-10% reduction in body weight over a period of several months to a year. It should be noted that rapid weight loss may be harmful and detrimental.
Cardiovascular exercises like jogging, cycling or swimming are recommended. One should try to achieve 150 minutes of exercise per week. This should be a gradual and sustainable process. It is important to maintain the weight loss, otherwise it will be counterproductive. Please consult your doctor before embarking on a weight loss exercise regime.
Diet also plays an important role in the management of NAFLD. A balanced, nutritious diet can help to manage your weight and reduce the risk of insulin resistance, thereby helping to protect against the development of NAFLD.
The best diet is one that promotes healthier blood-sugar levels and improves cardiovascular risk factors. The amount of food intake does play a role, especially if one is consuming more than the amount his/her body needs. This is because the excess will be converted into fat and stored in the body. Similarly, serving portion sizes are equally important.
Besides the amount of food intake and serving sizes, it is also important to take more plant foods, such as fruits, vegetables, nuts and seeds. These foods have protective compounds, such as fiber and antioxidants. Fiber is also filling and can help to reduce food intake.
On the other hand, there are certain foods which should be avoided. Refined carbohydrates, such as white bread, white rice, pizza dough, pasta, noodles and many breakfast cereals, turn into blood sugar more quickly. A fast rise in blood sugar levels makes the body’s insulin less efficient, which then sets the scene for insulin resistance. Therefore, in order to manage one’s weight, processed foods should be replaced with natural ingredients to facilitate better weight management.
Reducing the intake of sweetened drinks like soda is also helpful. These drinks are the leading source of excessive sugar in our diets. They are highly associated with NAFLD because they can easily travel into our liver where it promotes fat deposition. Also, the importance of alcohol abstinence cannot be overstated. Alcohol has no nutritional value and may further damage your liver.
CARDIOVASCULAR RISK FACTORS
It is strongly recommended that there should be strict control of cardiovascular risk factors like high blood pressure, high cholesterol level and diabetes mellitus. These conditions can lead to NAFLD. Therefore, you should keep to a regular checkup schedule with your doctor to ensure these conditions are optimally managed and do not progress to NAFLD. In recent times, there is emerging evidence that some medications can help with the management of NAFLD. However, this approach has to be individualised. Do consult your doctor on which treatment is most appropriate for you.
In conclusion, fatty liver has become an increasingly common condition with high prevalence in metabolic syndrome. Fatty liver is mostly asymptomatic during its early stages. The early detection of fatty liver can help in modifying the disease’s course. This can be achieved through lifestyle modification, including diet control and physical exercise. Optimising the control of cardiovascular risk factors is also crucial. By doing these, you can help protect yourself from irreversible liver damage. A healthy liver begins with you!
Dr Chin Yung Ka
Gastroenterology and Liver Specialist Clinic
MBCHB(UK), MRCP(UK), FAMS