Fatty Liver – what is it and how does it affect you?

Fatty liver is a relatively common condition that we see at OneWelbeck Digestive Health. In this article, Professor Hemant Kocher, Consultant General and HPB (hepato-pancreatic-biliary) Surgeon at OneWelbeck, takes a closer look at fatty liver, what causes it, and the different courses of treatment available.

Your liver is made up of lots of cells. The main cells are called hepatocyte. There are other types of cells but there are no fat cells in the liver. So if your liver is fatty then the hepatocyte has lost its normal structure and has started accumulating fat. This can be picked up using either blood tests or a simple scan such as an ultrasound, but a clearer picture will be obtained by combining these two diagnostic investigations. There are more specialist tests for understanding how severe the fatty liver is.

A fatty liver is not a good sign, and it certainly indicates that the liver is not healthy. If severe, it can cause serious health issues. These include liver failure, kidney failure, and heart conditions, as well as high blood pressure and cancer. Fortunately, in most instances it is mild and most importantly it can be reversed by making a few healthy choices. Usually, no medications are required in early stages or even in a mild case of fatty liver. However, this condition needs to be monitored by a liver specialist. It is surprisingly common with 1 in 3 adults in the UK suffering from this problem, often undiagnosed. The reason most often fatty liver is not diagnosed is because it does not cause symptoms.

There are many causes of fatty liver. The commonest cause is being overweight. This is true if your body shape is ‘apple’ type that means more fat around the waist. Other common reasons are high blood pressure, diabetes (mainly seen in Type 2), smoking, and high cholesterol. A combination of these conditions increases the risk of getting fatty liver.

The best way to treat fatty liver is to reduce weight and treat any underlying conditions such as diabetes, high blood pressure and cholesterol well. Then it requires regular monitoring by a liver specialist.

The progression of fatty liver disease can take years, even decades. Although the process can be slowed or even reversed in some cases, through lifestyle changes and sustained weight loss, it can also slowly worsen over time, causing scarring or “fibrosis” to appear and accumulate in the liver. As this scarring worsens, cirrhosis develops, where the liver is permanently damaged and is no longer able to function properly. At this stage, liver transplantation surgery is the only available treatment.

Bariatric surgery may also be suggested to reduce weight and prevent fibrosis developing in non-cirrhotic or compensated cirrhotic patients. Several different procedures are available, including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy and laparoscopic adjustable gastric banding (LAGB). Each of these procedures have their benefits and risks, and so the procedure would need to be individualized according to the patient’s condition.

Currently, there are no medications that have been approved to treat fatty liver disease, and as such it is difficult to classify when a patient has been ‘cured’. With that said in many cases, lifestyle changes can help to reverse fatty liver disease progression and can help prevent liver damage and scarring. Lifestyle changes which may be recommended by your doctor include limiting or avoiding alcohol, losing weight, and making changes to your diet, especially limiting your intake of foods high in saturated fats.

Fatty liver disease is usually first suspected when elevated levels of certain liver enzymes, namely alanine aminotransferase (ALT) or aspartate aminotransferase (AST), are detected during routine blood tests.

If your doctor suspects that you might have a fatty liver, they will likely ask you questions about:

• Your family medical history, including any history of liver disease
• Your alcohol consumption and other lifestyle habits
• Any medical conditions that you might have
• Any medications that you might take
• Recent changes in your health

If you’ve been experiencing fatigue, loss of appetite or other unexplained symptoms, let your doctor know. As mentioned previously, fatty liver disease often progresses very slowly over years, however early detection is preferred before significant scarring has developed, when lifestyle changes are more likely to provide significant benefit to patients without the need for surgery.