news-events/february-current-understanding-of-fatty-liver-2022

Current Understanding of Fatty Liver

“Fatty liver” is very commonly diagnosed these days during a USG scan done for other reasons/purposes. It is not a diagnosis to be alarmed about but it implies that one is not okay with respect to metabolism. Fatty liver usually represents the “liver-related component” of metabolic syndrome.

Excess fat/excess carbohydrates that are consumed and not burnt, get accumulated in the liver as fat. This is a long-term accumulation over a period of months to years. This can happen in both lean/obese individuals, males or females, young or old.

Diagnosis of NAFLD (non-alcoholic fatty liver disease), however, requires exclusion of significant alcohol consumption (defined as < 21 drinks/week for males & < 14 drinks/week for females; 1 drink = 14g of alcohol) and also certain liver disease like hepatitis C/Wilson’s disease which may present as fatty liver on USG.

Once a diagnosis of NAFLD is arrived at, the next step is to know if there is hepatitis +/- fibrosis: 75% of NAFLD patients do not have a liver injury. Only about 25% progress with time to liver injury/liver damage. Liver injury is practically assessed with LFT (liver function tests) and liver fibrosis is assessed with a special scan called fibro scan. If liver function tests are deranged and if fibrosis is significant, it is desirable to start treatment for NAFLD.

The most important component of treatment is diet & lifestyle modification. The goal of treatment is to achieve 10% of weight loss from the initial body weight. Diets are aimed at changing the type of food intake (e.g., Mediterranean diet), calorie restriction and changing timing of meals. Lifestyle modification includes avoidance of sedentary life. Aim for physical activity of 150 minutes/week (moderate intensity exercises).

Sustaining a weight loss of 10% body weight requires a commitment to the cause, which is difficult for most patients. Hence, there is a role for pharmacotherapy in NAFLD patients. Most of the drugs deemed to be good for treating NAFLD are in phase II/III trials and these drugs will become norm in future. Until then, diet/ lifestyle changes will remain as the cornerstone for management of NAFLD.