1. What is fatty liver?

Fatty liver refers to the abnormal build-up of fat in the liver cells. Fatty liver disease covers a range of conditions including simple fatty liver (called hepatic steatosis), which is common, and steatohepatitis, which is associated inflammation of the liver that may lead to the serious condition of cirrhosis (scarring of the liver).

2. What causes fatty liver?

Excessive intake of alcohol is a common cause but it is becoming increasingly common in people who are overweight or obese. As type 2 diabetes becomes more common in our community, so does the incidence of fatty liver disease. The causes can be summarized as follows:

The big three

• Alcohol excess
• Overweight and obesity
• Diabetes

Others

• Crash diets
• Starvation and protein malnutrition
• High blood lipids/cholesterol
• Intestinal bypass surgery
• Drugs (e.g. tetracycline, cortisone, various hormones, amiodarone)

The combination of being overweight and drinking too much alcohol makes people very prone to developing a fatty liver. This also increases their risk of developing diabetes, which perpetuates the problem.

Contrary to popular opinion, fatty liver is not necessarily caused by eating too much fatty food.

3. How common is non-alcoholic fatty liver disease?

This modern epidemic facing the Western world is directly related to the global increase in obesity. It is the most common cause of abnormal liver function

4. How does fat get into the liver?

In normal conditions, fat from our diet is processed by the liver and any excess is stored in the body tissues. In some people, especially people who are overweight or obese, some of the excess fat accumulates in the liver.

5. What are the symptoms?

A person with a fatty liver is not necessarily ill. Usually there are no symptoms because the fat accumulates slowly. Some people complain of vague tiredness or a lack of energy. Your doctor may be able to feel an enlarged liver.

6. How is fatty liver diagnosed?

Blood tests of the liver may or may not show abnormalities but special tests, such as an ultrasound or CT scan, may show up fatty liver.

The commonest method to diagnose fatty liver disease is by a specialist ultrasound termed FibroScan. In rare instances, a biopsy of the liver may be required.

7. What is the outlook?

Simple fatty liver usually causes no problems and rarely progresses to the serious problem of liver cirrhosis (scarring). Depending on the cause, a fatty liver may be helped if the patient stops drinking alcohol, loses weight and improves control of diabetes.

8. What about fatty liver in pregnancy?

This is a rare but very serious condition of unknown cause that develops close to term in the pregnant woman. It causes several uncomfortable symptoms including jaundice, nausea, vomiting, headache and abdominal pain. It has a high death rate and urgent delivery by caesarean section is required.

9. How is fatty liver treated?

There is no proven cure but it is important to treat causes, such as diabetes and obesity. Avoiding alcohol and drugs that may affect the liver is also important. The treatment of steatohepatitis is avoidance of alcohol and achieving ideal weight (if applicable). Talk to your doctor about this if you are concerned.

10. How can fatty liver be prevented?

Prevention is based on following a healthy lifestyle.

• Do not drink excessive amounts of alcohol.
• Watch your diet—eat sensibly and avoid eating too much.
• Don’t diet excessively—avoid long periods without food and include an adequate amount of protein in your diet.
• Take regular exercise.