Fatty Liver

Fatty liver is not a liver disease as such. It simply means there is more fat in the liver than normal. A person with a fatty liver is not necessarily ill.

Fatty liver can be caused by certain chemical compounds and by nutritional and endocrine disorders. Alcohol is by far the most common drug cause. Nutritional causes of fatty liver are starvation, obesity, protein malnutrition and intestinal bypass operations for obesity. The endocrine disorder diabetes mellitus often leads to fatty liver. These causes of fatty liver are called non-alcoholic fatty liver disease or NAFLD.

In all of these conditions the fatty deposits are occasionally accompanied by some inflammatory changes and scarring of the liver. Doctors call this condition non-alcoholic steatohepatitis or NASH.

Fatty liver of pregnancy is a serious condition occurring near term. Premature termination of pregnancy may be necessary. Delivery of the baby by Caesarean section may be a life-saving measure.

What are the symptoms?

Uncomplicated fatty liver does not usually produce symptoms because fat accumulates slowly. The liver may be enlarged on physical examination. In fatty liver of pregnancy there may be nausea, vomiting, abdominal pain and jaundice.

How does fat get into the liver?

Fat enters the liver from the intestines and from the tissues. Under normal conditions, fat from the diet is metabolised by the liver and other tissues. If the amount exceeds what is required by the body it is stored. In obesity some of the fat accumulates in the liver.

Can fatty liver lead to other liver disease?

Fatty liver in people who drink too much alcohol is sometimes followed by more serious liver damage in the form of alcoholic hepatitis. Serious liver damage is less common in diabetes and obese people who donʼt drink but if the fat has progressed to NASH then further progression to scarring and even cirrhosis can occur.

How is fatty liver treated?

There is no proven effective drug treatment. However, there are some steps you can take that may help prevent or reverse some of the damage. In general, if you have fatty liver, and in particular if you have NASH, you should:

• Eat a balanced, healthy diet
• Lose weight gradually. That usually means losing no more than 0.5 to 1.0kg a week.
• Increase your physical activity
• Lower your triglycerides through diet, medication or both
• Avoid alcohol
• Control your diabetes, if you have it

How can I avoid fatty liver?

Do not drink to excess - alcohol can decrease the rate of metabolism and secretion of fat, leading to fatty liver. Overweight patients may have fatty liver, and are also at risk for several more serious conditions such as high blood pressure, stroke, diabetes and heart disease. It is a good idea to watch
your diet: starvation, excess dieting and protein malnutrition can also result in fatty liver.

For further information visit the NZ Society of Gastroenterology and Gastroenterological Society of Australia websites.