The Danger of Fatty Liver Disease
By Christine Pocha, MD, PhD, MPH, FAASLD, Avera Medical Group Liver Disease Sioux Falls
This is the first of two blogs looking into non-alcoholic fatty liver disease (NAFLD).
The liver is an important organ in your body – it’s involved in more than 500 tasks and several thousand chemical reactions every day. It converts nutrients from food into energy, produces substances our body needs like proteins and antibodies and stores these substances until your body is ready to use them.
When we consider its importance, we also have to look at threats to this vital organ. One that’s often misunderstood is fatty liver disease. A medical umbrella term “non-alcoholic fatty liver disease” or NAFLD, refers to a fatty liver condition not related to alcohol use.
NAFLD usually doesn’t cause any symptoms. It is often first detected by accident when an abdominal ultrasound, CT scan or MRI is completed for another reason or as part of blood tests for abnormal liver. Misunderstanding the disease won’t make it go away, so let’s consider some myths that surround this condition.
Myth 1: It’s Nothing to Worry About
NAFLD refers to a build-up of fat in the liver, and any buildup that amounts to 5 percent or more of the total organ size is considered a problem. Fatty liver literally means your liver cells fill with fat, paving the path for damage and inflammation.
NAFLD is divided into two groups:
- Non-alcoholic fatty liver (NAFL), otherwise known as simple fatty liver (steatosis)
- Non-alcoholic steatohepatitis (NASH)
It is important to distinguish between the two. Simple fatty liver does not cause much harm. On the other hand, NASH can lead to inflammation and injury of your liver cells, and increase risks of scarring (fibrosis). Untreated it can also cause cirrhosis, which is a later stage of the scarring, and sometimes liver cancer. NASH-related cirrhosis will be the No. 1 reason people will require liver transplants in the very near future.
Myth 2: Fatty Liver Disease is Rare
Fatty liver is on the rise worldwide. It now affects roughly 20-40 percent of the population of the United States, due mostly to unhealthy diet and higher rates of obesity. The signs that you might face it include:
- Being overweight
- Having high levels of blood fat – either triglycerides or LDL “bad” cholesterol
- Having diabetes or prediabetes
- Having high blood pressure
Myth 3: A Biopsy is the Only Way to Know
When determining whether or not a patient has fatty liver disease, a liver biopsy is considered the best way – the “gold standard” of diagnosing – for most patients. It can also detect many other conditions affecting the liver. In fact, to distinguish between simple fatty liver and NASH, a biopsy would be needed.
However, there are noninvasive ways to identify patients who face the greatest risk for fibrosis, such as the use of biomarkers and scoring systems based on blood tests. These steps can help patients, and so too can an elastography, which uses soundwaves to estimate fibrosis based on the stiffness of the liver. This test, called the “Fibroscan" is a quick office based test, and is often recommended.
These tests can help determine if you or someone you love who faces liver disease will need a biopsy. We’ll consider other fatty liver myths – and provide steps to avoid this condition – in the second part of the blog.