Fatty infiltration of the liver, also known as steatosis, can be due to a variety of causes, including lcohol, medications, hepatitis C, diabetes, pregnancy, obesity and metabolic syndrome. According to research outlined in the June 2006 issue of "American Family Physician," fatty liver associated with metabolic syndrome is one of the most common causes of elevated liver enzymes in the United States. Medicines are typically not used to treat fatty liver unless it is associated with another medical condition.
Physiology
Fatty liver results from the accumulation of excess triglycerides in your liver cells. Toxins, infections and insulin resistance impair your liver's ability to process fatty acids, so these lipids are temporarily packaged and stored as triglycerides. Likewise, a high fat or high carbohydrate diet or sudden, dramatic weight loss can lead to the delivery of excess triglycerides to your liver. Triglycerides are inherently inflammatory, and their prolonged presence in liver tissue causes cellular injury. The treatment of fatty liver is generally aimed at its underlying cause.
Metabolic Syndrome
In the 1980s, researchers described a constellation of physiologic traits that are associated with a higher risk for diabetes and heart disease. These characteristics -- high blood pressure, abdominal obesity, glucose intolerance and either high triglycerides or low HDL cholesterol -- are now called metabolic syndrome. People who have metabolic syndrome often have a fatty liver, as well. Metformin, glitazone drugs, blood pressure medications and cholesterol lowering agents are often used to treat the various components of metabolic syndrome, but they are not typically used to treat fatty liver alone.
Complications
The course and prognosis of fatty liver are somewhat controversial. The American Gastroenterological Association reports that most people with fatty liver do not have symptoms, nor do they develop end-stage liver disease, also known as cirrhosis. Their condition is often discovered during abdominal ultrasounds performed for other reasons or during investigations to determine the reason for elevated liver enzymes. However, people with a fatty liver exhibit a higher mortality rate than the general public, probably due to the underlying conditions that are associated with a fatty liver.
Considerations and Recommendations
Currently, fatty liver does not warrant treatment with medications unless it is associated with another medical condition. Some drugs, such as metformin and rosiglitazone, have demonstrated the ability to improve liver appearance and reduce liver enzyme levels in people with fatty liver disease. However, there is insufficient evidence to show that such treatments improve the long-term prognosis for people who only have fatty liver infiltration. The treatment of steatosis involves weight loss and exercise to improve insulin sensitivity. Limiting your consumption of fats and and sugars may also be helpful. If you have a fatty liver, your doctor can explain your treatment options.
References
- "The Merck Manual of Diagnosis and Therapy, 18th Edition: Fatty Liver"; Mark H. Beers, M.D., Editor-in-Chief; 2006
- "American Family Physician"; Nonalcoholic Fatty Liver Disease; M. Bayard, et al.; June 2006
- "American Family Physician"; Metabolic Syndrome: Time for Action; D. Deen; June 2004
- "Gastroenterology"; AGA Technical Review on Nonalcoholic Fatty Liver Disease; A.J. Sanyal; 2002
