The rate of fatty liver disease is growing with the rise in obesity rates in the United States. This silent disease often progresses from a small buildup of fat to a state in which the liver is hard and parts of it begin to fail. You may not feel any symptoms until the disease is advanced, so it's important to have your health care provider check your liver health, particularly if you drink alcohol or are overweight. Fatty liver disease is not fully understood by medical science. For example, most instances of the problem occur in people who drink excessively and in those who are obese. But fatty liver can progress to a point and stop, and even reverse without any treatment, and more healthy-weight people and children are being diagnosed with fatty liver disease as well. No established medical treatment for fatty liver disease exists.
Fatty Liver Disease in the United States
The liver is your body's second largest organ. This powerhouse of an organ is perched underneath your rib cage on your right side. It processes chemicals, assists with metabolism and digestion and produces fats and cholesterol for important body functions. More than 100 liver diseases exist, but there are just two major forms of fatty liver disease---alcoholic and nonalcoholic. The two forms are similar and differ primarily by how much you drink. That is to say, a person who grows obese can suffer the same damage to their liver that alcoholics experience, even if he drinks little to no alcohol. Fatty liver disease is progressive, starting with just a bit of fat and resulting in complete organ failure.
Fat in the Liver
Many people have a little fat in the liver. A little bit is not harmful, but when fat starts to comprise about 5 percent of your liver weight, you've got a fatty liver, says the American Liver Foundation, or ALF. This is called simple hepatic steatosis. Deposits of fat in your liver cause it to enlarge. According to the National Institutes of Health, a fatty liver is typically due to an accumulation of fatty tissue, mostly triglycerides, with your liver cells. Your liver produces triglycerides and you also eat them, so any number of factors could collide and create a little too much fat in the liver. When you drink too much, says the NIH, you may get a fatty liver because of the effect of alcohol on the "redox state," or the balance of a number of synthesis and oxidation processes that occur in the liver. About 10 to 20 percent of Americans have some fat in their liver. When your doctor suspects you have a fatty liver because of the results of blood tests or a liver scan, this problem is called nonalcoholic fatty liver disease, or NAFLD.
Scarring
As fatty liver disease progresses, you can experience fibrosis. This happens when scar tissue starts to form in response to cell injury, and it's a sign that your liver is trying to heal itself. When you begin to experience the inflammation and fibrosis associated with fatty liver disease, you may be diagnosed with nonalcoholic steatohepatitis, or NASH. As with simple steatosis, you will probably feel physically well and not be aware that you have a liver problem. NASH is also diagnosed through blood tests or an examination of your liver. Despite its stealth, NASH is a serious problem. It affects about 2 to 5 percent of Americans, according to the NIH. Along with significant scarring and liver cell injury, NASH patients may experience ballooning of liver cells or liver cell death. NASH frequently accompanies obesity and type 2 diabetes. The NIH says most people who have NASH also have insulin resistance, which may be a factor in the worsening of their liver problems.
Cirrhosis
NASH can take years to progress, but it is responsible for about 10 percent of new chronic liver disease diagnoses and 10 percent of cirrhosis cases. If your fatty liver condition progresses unchecked, the organ can become so damaged that it can no longer repair itself, and the damage is irreversible. If you haven't been monitoring your liver health with your health care provider up to this point, this is probably when you'll begin to feel symptoms, such as fatigue, bruising, jaundice, itching, a drop in weight and weakness. Unfortunately, it may be too late. Cirrhosis can lead to several complications, including liver cancer and a buildup of toxins in your brain.
Liver Failure
Liver failure happens when your liver has lost its ability to function. This is a life-threatening condition, and urgent care is warranted. When your liver fails, you may not connect your symptoms, such as nausea, diminished appetite, fatigue and diarrhea, with a liver problem. But these symptoms become increasingly more profound, and you can become confused, disoriented and extremely sleepy when your liver is failing, says the ALF. Your only option may be a transplant.
References
- National Institute of Diabetes and Digestive and Kidney Diseases: Action Plan for Liver Disease Research: Chapter 7 Fatty Liver Disease
- National Digestive Diseases Information Clearinghouse: Nonalcoholic Steatohepatitis
- American Liver Foundation: NAFLD
- American Liver Foundation: The Progression of Liver Disease
- Mayo Clinic: Nonalcoholic Fatty Liver Disease
- "American Family Physician"; Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation; Joel Heidelbaugh and Michael Bruderly; September 2006
