Fatty Liver Disease: A Precursor for Liver Scarring and Cancer

Did you know that fatty liver is the most prevalent liver disease in Western world, affecting 20% of Americans? Non-alcoholic fatty liver disease (NAFLD) is also the most common form of chronic liver disease in the United States, affecting approximately 80 to 100 million people?

In Asia, this epidemic is also worsening with increasing obesity and diabetes rates. In some countries the prevalence of fatty liver is over 40%. Overall the prevalence is also estimated around 20%.

What is Fatty Liver? What Are its Consequences if Left Untreated?

The liver is our detox powerhouse responsible for removing toxic and harmful substances, synthesising proteins and vitamins, and aids in the digestion process. If your doctor tells you that you have fatty liver, this means that you have abnormally high level of fat in your liver. A healthy liver should contain little or no fat. If more than 5% – 10% of your liver’s weight is fat, then you have a fatty liver.

Fatty liver tends to be caused by alcohol consumption or even more commonly associated with obesity, diabetes, insulin resistance and metabolic syndrome.

Alcohol-related fatty liver disease (ALD) is caused by heavy alcohol drinking. Many people with ALD don’t have any symptoms at all during early stages of disease. However, if your liver becomes enlarged, you may feel pain in the upper right side of your abdomen. Abstaining from alcohol usually leads to recovery of alcohol-related fatty liver diseases. ALD may progress to alcoholic hepatitis, which is swelling in the liver that can cause elevation of liver enzyme levels, fever, nausea, vomiting, abdominal pain, and jaundice (yellowish coloration of skin).

Over time, alcoholic hepatitis may turn into alcoholic cirrhosis, which is a buildup of scars in your liver. In addition to the symptoms of alcoholic hepatitis, there may be other health problems such as enlarged spleen, portal hypertension (high blood pressure in the liver), bleeding throughout the body, and mental confusion. Liver failure and liver cancers, which can be fatal, are the end stages of alcoholic cirrhosis.

Non-alcoholic fatty liver disease (NAFLD) is a very common metabolic disorder, and refers to a range of conditions caused by accumulation of fats in the liver due to causes other than excessive alcohol use. People who are overweight or obese usually suffer from NAFLD (up to 80% prevalence). High blood sugar and high blood level of fats are usually associated with NAFLD. Nonalcoholic steatohepatitis, a remarkably serious form of NAFLD, is characterised by liver inflammation, which may lead to fibrosis or scarring and irreversible injury. This damage is very similar to the damage caused by excessive alcohol consumption. The untreated cases of non-alcoholic steatohepatitis may progress to cirrhosis, liver cancer or liver failure.

How to Screen for Fatty Liver?

Several methods of diagnosing fatty liver exist. The most common blood liver function tests to screen for liver damage (non-specific to any cause of liver damage) and monitor the extent of the damage is called a liver panel which includes:

  • Alanine transaminase (ALT) and aspartate transaminase (AST) and gamma glutamyl transferase (GGT) are enzymes you have in your liver. You might have high levels of enzymes if you have liver damage.
  • The liver produces two main proteins: albumin and globulin. Low levels of both proteins indicate liver damage or disease.
  • Bilirubin is the breakdown product of aged red blood cells. Generally, your liver removes bilirubin from your body. If you have high levels of bilirubin in your blood, you are very likely to have liver damage.

In addition to blood liver functions test, your doctor may also recommend more specific tests to diagnose fatty liver with imaging techniques such as abdominal ultrasound, abdominal CT, body MRI, ultrasound elastography, and magnetic resonance elastography. Liver biopsy, an invasive procedure, can also be considered to assess and estimate the degree of liver damage.

LiverFASt is a non-invasive blood test used to provide physicians with simultaneous and complete assessment of the liver injury. LiverFASt is a combination of three tests including liver fibrosis, liver steathosis (fatty) and liver inflammation. It gives a score to each measurement for ease of interpretation and future monitoring of disease progress.

How Can Fatty liver be Treated?

Did you know that weight loss through both healthy diet and exercise is the first line of treatment? In fact, excellent results appeared in hepatic patients who lost significant amount of body weight. The following ways are recommended to have a healthy liver:

  • Reducing the number of calories you eat is the pivotal step to losing weight and controlling liver damage.
  • Eating a healthy diet such as fruits, and vegetables showed good results for patients with liver disease.
  • You should exercise regularly for at least 30 minutes most days of the week, if you want to have a healthy liver.
  • If you are diabetic, you shall take your medications as prescribed by your doctor to control your blood sugar level, and just as importantly stick to your diet regime for diabetes.
  • You should lower your blood cholesterol and triglyceride levels by eating plant-based diet, practicing sports and taking medications such as statins and bile acid sequestrants if exercise and diet alone cannot do the work.
  • You can protect your liver by taking liver supplements such as vitamin E and silymarin, abstaining from alcohol, and following the instructions of all medications.

When Should You See a Doctor?

The following symptoms require medical attention, and should not be ignored:

  • Severe persistent abdominal pain
  • Yellowish coloration of skin
  • Itchy skin
  • Dark urine color
  • Pale stool color

Your liver is a vital organ, and a healthy lifestyle is essential to keep your liver healthy. Although having a fatty liver may seem trivial, the negative consequences of fatty liver can be disastrous.


If you’re interested in learning more about your liver and alcohol’s effect on it, read on more about it in our other post here!

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