Fatty liver: causes, symptoms and therapies

Today considered the most frequent chronic liver disease, it is a growing disorder that, if neglected, can cause serious complications.

Scientifically it is called non-alcoholic fatty liver disease, but it is commonly known as fatty liver, because this condition is characterized by an excessive accumulation of fats, especially triglycerides, inside the liver cells. A silent disorder but that can, in some cases and over time, compromise the functionality of the liver.

In the vast majority of cases it is macversicular steatosis, but there is also a form called microvesiccular. Let’s see how they differ.

Features
Macovericular steatosis The accumulation of fats comes in the form of large “drops” that greatly swell the liver cells
Microvesicular steatosis The fat collects in much smaller drops around the organelles of the cell giving it, when observed under a microscope, a “foamy” appearance.

From the point of view of etiology, steatoses are divided into alcoholic and non-alcoholic steatoses.

Several factors at the origin

There are several causes that can contribute to determining a fatty liver, but an incorrect and high-calorie diet certainly plays a primary role, especially if combined with a sedentary lifestyle: it facilitates the formation and accumulation of new fat in the liver and the non-use of that already present in it.

The following are therefore established risk factors:

  • obesity
  • type 2 diabetes or insulin resistance
  • dyslipidemias, in particular an excess of triglycerides, and metabolic syndrome, in turn often linked to an incorrect lifestyle.

Sometimes, finally, non-alcoholic fatty liver disease can appear due to genetic predisposition or following some pharmacological treatments.

Does not give symptoms

Non-alcoholic fatty liver disease does not give symptoms and is generally discovered by chance, while investigations are made for other disorders or routine analyzes. It can cause a slight but chronic increase in blood values of transaminases and other liver enzymes, but to arrive at the diagnosis it is necessary to exclude any other diseases affecting the liver.

Although the fatty liver appears brighter on ultrasound, liver biopsy is required for differential diagnosis. It also allows to determine the degree of severity of the disease: the fatty liver, in fact, can evolve slowly, but gradually, towards more severe forms, which involve a degeneration of liver tissues, leading to chronic inflammation (steatohepatitis), cell death (steatonecrosis) or their replacement with hardened scar tissue and nodules (fibrosis), up to irreversible damage (cirrhosis), with impaired organ function.

Not all those who suffer from fatty liver undergo this progression, which is generally very slow, but there are subjects genetically predisposed to a more rapid and dangerous degeneration and who must therefore be identified and treated as soon as possible.

Complications

Alcoholic fatty liver disease is often accompanied by inflammatory and necrosis processes, which can lead to cirrhosis.

Even a small percentage (5 to 20 percent) of liver steatoses that have other origins evolve into inflammatory or necrotic processes that can give rise to non-alcoholic steatohepatitis (or NASH).

If these inflammatory processes do not make their appearance, hepatic steatosis is reversible with the correction of the factors that induced it.

Lifestyle needs to be corrected

The first and main therapeutic strategy against fatty liver consists in lifestyle correction.

At the table, guided by a nutritionist, a diet that follows the dictates of the Mediterranean diet is indicated, with a low intake of fats thanks to the abundance of foods of vegetable origin, such as fruit, cereals, vegetables, legumes and spontaneous and aromatic herbs, moderate quantities of fish, poultry and dairy products and low quantities of red meat, as well as favoring olive oil as a substantial condiment, avoiding alcohol completely.

The diet should also be combined with regular and constant (usually at least an hour a day) aerobic physical activity (jogging, running, swimming, cycling).

Treatments

On the treatment front, various options are being evaluated, including antioxidant supplements, particularly vitamin E, drugs normally used to treat diabetes or hypertension, and others that counteract excess triglycerides.

However, pending clear indications from scientific studies, any therapies, which may be necessary in advanced cases (in which steatohepatitis is already present) are evaluated and customized on a case-by-case basis by specialists.

When to consult your doctor

The doctor should always be consulted if you notice an enlarged liver, and in any case for periodic checks if you are among the people at greater risk, ie if you suffer from obesity, overweight, diabetes, hyperlipidemia, or if some family member suffers or has suffered from the same problem.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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