Fatty Liver - Modern Lifestyle Related Epidemic

Fatty liver is a disease in which liver has excessive fat. Fatty liver is seen commonly on routine abdominal ultrasound. Fatty liver is like modern day epidemic. Possibility of fatty liver seen in general population is as high as 25%. This prevalence varies from place to place. We can imagine high prevalence of fatty liver in general public form the fact that many prospective donors, who want to donate part of their liver to their relatives, have been found to have fatty liver on routine screening and eventually needing treatment. During these tough times of COVID-19 pandemic, its further important to know about fatty liver. The families are at home during lockdown, the diet pattern has changed to junk food. Different dishes are being tried at home. Parents has stuffed homes with junk food in form of frozen bites, ice cream, chocolates, chips etcetera. The food intake has drastically increased in view of being at home, lack of routine. In addition to food intake, walks, gym and swimming pools has been stopped. This eventually affects the overall health.

It is mostly related to alcohol consumption, junk food, sedentary life style and lack of physical work. Junk food such as chips, burger, pizza, frozen fast food contains high carbohydrate, high fat and low proteins. Fatty liver is common among persons consuming more junk food, take more refined carbohydrates in diet and sugary beverage consumption. Persons with modern lifestyle lack physical work, have more work-related pressure, more target related pressure, competition, more screen time on computer and mobile. Such lifestyle leads to binge eating and junk food eating in addition. Mixture of all of above factors leads to fat deposition in liver.

Alcohol intake for long duration and large quantity can damage the liver sooner than a teetotaler person. Such insult of liver due to toxins like alcohol leads to a repeated process of injury and healing lead to scar formation in liver, which is seen in form of shrunken and hard liver, known as cirrhosis of liver. Cirrhosis of liver can not only decrease expected survival but also leads to poor quality of life. Such patients, sometime need to be considered for timely liver transplant.

Teetotaler persons are less affected than alcoholic person but they are not immune to liver diseases. Poor lifestyle, as discussed above, bad eating habits, and a few medical conditions like overweight and obesity, excess belly fat, type 2 diabetes, deranged lipid profile, raised cholesterol can lead to fatty liver in anyone. Combination of factors is worse than single factor. 30-90% of obese persons can develop fatty liver. Fatty liver disease not associated with alcohol is called NAFLD (non-alcohol fatty liver disease). It may be associated with other alcohol and obesity related diseases such as hypertension, diabetes, heart disease.

Fatty liver is initial stage of liver injury, which often goes undiagnosed. If not managed appropriately, fatty liver can progress to steatohepatitis (inflammation), fibrosis, cirrhosis. Fatty liver disease often goes unnoticed, generally detected by chance on ultrasound of abdomen; or deranged liver function in blood tests. Although, sometimes such patient can present with vague symptoms like fatigue, weakness, loss of appetite, pain abdomen, jaundice, nausea. The severity of fatty liver can be diagnosed by ultrasound abdomen, and Fibroscan, which is liver specific scan. Fatty liver can be divided in four grades, grade 1 to grade 4. Higher the grade, more the severity and more chances of progressing further.

It is to be noted that fatty liver is a reversible disease, if managed appropriately. Patient needs to do life style modification, in terms of quitting alcohol and smoking. Diet modification, regular exercise and weight reduction remains key to the treatment. Diet modification includes cutting down on carbohydrates, avoid sweetened beverages, with maintenance of adequate protein diet and monounsaturated fat like olive oil and nuts. The exercise can be a mixture of high intensity and low intensity, aerobic exercises. The duration needs to be about 150 to 250 minutes per week; 20-30 min daily.

As true with all other diseases, prevention is better than cure. The way to prevent remains with well-balanced diet, low in saturated fats and high in fiber, minimize sugar consumption, reduce the intake of fried food. In addition, introduce exercise into your routine, at least four times a week, avoid alcohol. There have been studies to guide different diets, which can be helpful in treating fatty liver. Fish oil has been shown to reduce liver fat and aspartate aminotransferase levels. Coffee has a multi-pronged effect on liver disease, reducing the type 2 diabetes and cardiovascular disease. Nuts, olive oil, green and black tea reduce blood fats like cholesterol, liver fat and inflammation.

Do not ignore the disease, meet your physician and follow treatment with consultation. Lifestyle modification remains the key to both prevention and treatment.