By Dr. David Bernstein, specialsections@antonmediagroup.com
Fatty liver disease is the most common liver disease in the United States, affecting more than 60 million Americans. Its prevalence is on the rise and it is estimated that more than 20 percent of Hispanics and 10 percent of African Americans have this condition. Fatty liver disease affects adults as well as children. Simply put, fatty liver is a condition whereby fat gets deposited into the liver. There is a spectrum of fatty liver disease which includes just fat, fat and inflammation, fat and fibrosis and cirrhosis. There are many causes of fatty liver including alcohol use, obesity, diabetes, and the use of certain medications such as corticosteroids or amiodarone.
Fatty liver is a generic term for many conditions which affect the liver. Fatty liver associated with alcohol use is termed alcoholic liver disease and will not be discussed in this article. Fatty liver which is not associated with alcohol use in which inflammation or scarring is present within the liver is called non-alcoholic steatohepatitis or NASH.
Steatohepatitis can progress to cirrhosis, liver failure and liver cancer and physicians are seeing a greater number of patients with fatty liver disease progress to these complications. Although the percentage of people with NASH who progress to cirrhosis is low, large numbers of people develop advanced disease because the overall number of people with this condition is so high. Interestingly, patients with fatty liver can develop liver cancer without developing cirrhosis and these patients should be screened yearly with an abdominal ultrasound. Fatty liver is predicted to be the leading indication for liver transplantation in the next decade.
The diagnosis of fatty liver is usually suggested on an abdominal sonogram or CAT scan. Liver tests may be normal or abnormal. A liver biopsy is required to determine the extent of fatty infiltration and to see if inflammation or scarring is present. Transient elastography is still under investigation for this condition.
The most commonly prescribed therapy for NASH is diet, exercise and weight loss. Although this regimen makes overall good sense, studies have not shown that weight loss alone changes the course of fatty liver. Many people with fatty liver are placed on ursodeoxycholic acid to normalize the liver enzymes. Although this therapy is widely used, the jury is still out regarding its effectiveness. Vitamin E has been used in the treatment of NASH with some success. There are many new therapies for fatty liver in development and several of these are available in clinical trials.
For patients with non-alcoholic fatty liver, risk factors such as weight gain, poor glucose control and hyperlipidemia should be addressed with weight reduction and adequate glucose and lipid control. Since there is no strong evidence to support any one treatment strategy, physicians should carefully discuss the risks and benefits of proposed unproven therapies with their patient. The best treatment of fatty liver is prevention. Once fatty liver is present, diet and exercise are critical to prevent long-term complication.
David Bernstein, MD is chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and LIJ Medical Center. He is currently the professor of clinical medicine at the Albert Einstein College of Medicine.
