Have you ever heard of 'Fatty Liver'? Maybe it was on your scan report and you were scared. Many people think that this is a very dangerous disease. But what exactly is this accumulation of fat in the liver? Is it something to be afraid of? Let's talk about it all from the beginning, very simply.
What is Steatotic Liver Disease?
Simply put, this is the accumulation of fat, or oil, inside your liver. Doctors call this 'steatosis'. Even a healthy, well-functioning liver has a small amount of fat. That's normal. But if this fat accumulation exceeds 5% of the liver's weight, that's where the problem begins.
Think of it like the pipe in our kitchen sink. It's okay if a little water goes in. But if oil accumulates and gets stuck in the pipe, that's a problem, isn't it? That's how excess fat accumulates in the liver.
Why was the name 'Fatty Liver Disease' changed to 'Steatotic Liver Disease'?
In the past, we all called this condition 'Fatty Liver'. But in 2023, medical experts came together and decided to change this name. There were two main reasons for that.
1. Explain the cause: When people hear the word 'Fatty Liver', many people think that this only happens to obese people. But that's not the truth. Fat can also accumulate in the liver for many other reasons that have nothing to do with body weight. The new name gives a more accurate idea of the various factors that can cause this.
2. Eliminate the stigma and shame: The word 'Fatty' can be a bit of a stigma and shame for fat people. It's better not to use words that create that feeling when talking about a medical condition, right? That's why the name was changed.
What are the main types of fatty liver?
Doctors divide fatty liver into several main types depending on the cause. Let's see what they are. To make this easier to understand, I'll make a small table for you.
| Type of disease (Type of SLD) | Simple explanation |
|---|---|
| Alcohol-induced liver disease (ALD) | The main reason for this is excessive alcohol consumption . As alcohol is processed by the liver, it damages the liver cells. With continued, excessive alcohol consumption, the liver cannot repair this damage and begins to accumulate fat. |
| Metabolic syndrome (MASLD) | This used to be called non-alcoholic fatty liver disease. Here, the fat in the liver is not caused by alcohol, but by cardiometabolic risk factors such as diabetes, obesity, high blood pressure, and high cholesterol . |
| Metabolic syndrome (MASH) | This is a more serious form of the MASLD condition mentioned above. What happens here is that fat builds up in the liver, which then causes the liver to swell and become inflamed. Then the liver tissue starts to become damaged and scarred. |
| MASLD and excessive alcohol use (MetALD) | This occurs when someone has the metabolic risk factors mentioned above (e.g. diabetes) and also consumes too much alcohol. Here, both factors combine to damage the liver. |
| Other forms of SLD | Some medications and other diseases can also cause fat to build up in the liver. Sometimes, no clear cause can be found . This is called 'Cryptogenic SLD'. |
Is this really a serious problem?
In most cases, early fatty liver disease does not cause any major problems, nor does it interfere with the normal functioning of the liver.
But this is something that needs to be taken into consideration, like a 'warning signal' . It's like the yellow light on a traffic light turning on. If we act at that moment, we can control this before the red light turns on, that is, before a serious situation arises.
If this condition is left untreated, it can gradually become more serious in some people. It occurs in several stages:
1. Hepatitis: The liver, which is filled with fat, becomes swollen, red, and inflamed. This is called `Steatohepatitis`. This is how MASLD becomes MASH.
2. Fibrosis: Inflammation damages the liver tissue. Scar tissue begins to form in the damaged areas. Just like a scar forms when our skin is injured. This scarring causes the liver to become a little hard and rough.
3. Cirrhosis: This scar tissue continues to grow, replacing healthy liver tissue with scar tissue. This is a serious condition called cirrhosis. If cirrhosis is not treated, it can lead to liver failure and even fatal conditions like liver cancer.
That is why it is very important to identify this condition at an early stage, find out what the cause is, and seek the necessary treatment.
What are the symptoms of this disease?
The biggest problem with this is that it often doesn't show any symptoms in the early stages . You may not feel any difference. But some people may experience symptoms like these:
- A feeling of discomfort or heaviness in the upper right part of the abdomen.
- Fatigue is excessive tiredness and fatigue that occurs for no reason.
It is only when the disease has progressed to the point of cirrhosis that clear symptoms often begin to appear. At such a time, you may see things like:
- Nausea and vomiting.
- The food is tasteless.
- Weight loss without reason.
- Yellowing of the whites of the eyes and skin (jaundice).
- Abdominal swelling, fluid retention (Ascites).
- Swelling of the legs, ankles and hands (Edema).
What are the main causes and risk factors for fatty liver?
There are several possible causes for this. But the main ones are the metabolic risk factors we discussed earlier and alcohol use. You are more likely to develop this condition if you have one or more of these things:
- Alcohol addiction or frequent, heavy drinking.
- Metabolic Syndrome: This is the combination of several risk factors. That is, insulin resistance, high blood pressure, high cholesterol and triglyceride levels.
- Type 2 Diabetes .
- Overweight (BMI between 25 and 29.9) or obesity (BMI greater than 30).
- Polycystic ovary syndrome (PCOS) in women.
- Obstructive Sleep Apnea .
- Decreased thyroid hormones (Hypothyroidism) .
- Hypopituitarism (low levels of pituitary hormones) .
- Low sex hormone levels (Hypogonadism) .
- It can also occur as a side effect of some medications (e.g. Amiodarone, Diltiazem, Tamoxifen, Steroids).
How to diagnose this?
Most of the time, this is discovered by chance. When you have a blood test for another condition, your doctor may notice that your liver enzymes are elevated. That's the first clue.
After that, you can refer to the following tests to confirm the disease:
- Your medical history and examination: Your doctor will ask you about your medical conditions, alcohol use, and medications you take. He or she will also perform a physical examination to check for signs of liver inflammation and cirrhosis.
- Scans: Ultrasound, CT Scan or MRI can be used to check for fatty deposits, swelling and scarring in the liver. A special ultrasound scan called FibroScan can also measure the amount of fat and stiffness (scarring) in the liver.
- Liver Biopsy: In some cases, a very small piece of liver tissue is taken and examined under a microscope to determine the severity of the disease. This is the best way to accurately differentiate between MASLD and MASH.
How is it treated? Can this be cured?
There is no specific cure for this yet. But don't worry. As a treatment, doctors focus on controlling the risk factors that caused it. That means making healthy changes in our lifestyle.
Your doctor may advise you to do things like:
- Stop drinking alcohol completely: Even if the fat in your liver is not caused by alcohol, completely stopping alcohol consumption is very good for your liver.
- Lose weight: Exercise, dietary changes as advised by a nutritionist, and certain medications (such as GLP-1RA) can help you lose weight. You may also consider bariatric surgery.
- Manage other medical conditions: Take your medications for conditions like diabetes, high cholesterol, and blood pressure as prescribed. In some cases, supplements like vitamin E may also be recommended.
- Get vaccinated against hepatitis A and B: These viral infections can be very dangerous if someone who already has some liver damage develops them. Therefore, getting these vaccines is a safety measure.
Our liver is an amazing organ. It has an amazing ability to repair itself to some extent. If you follow your doctor's instructions exactly, you can reduce the fat and inflammation in your liver, stop further damage, and sometimes even reverse the damage that occurred in the first place.
How to protect yourself from this situation?
The best way to prevent this condition from occurring is to maintain an overall healthy lifestyle.
- Exercise regularly: It is very good to do at least 30 minutes of sweat-inducing exercise a day.
- Limit or completely stop alcohol use .
- Maintain a healthy weight for your height.
- Eat a balanced diet: Eat more vegetables, fruits, legumes, nuts, and whole grains. Limit oil, sugar, flour, fast food, and red meat (beef, pork). Drink clean water instead of sugary drinks.
- If you have diseases like diabetes or high blood pressure, use the prescribed medication exactly .
It's best to talk to your doctor and get advice on what healthy lifestyle is right for you.
Take-Home Message
- Steatotic/Fatty Liver is a condition where the liver is over 5% fat. This is a very common condition.
- Factors such as alcohol use, diabetes, obesity, and high cholesterol are the main causes of this.
- Often, there are no symptoms in the early stages, so it can be a 'silent disease'.
- If this condition is ignored, over time it can lead to serious conditions such as cirrhosis and liver cancer.
- But don't worry! This condition can be controlled, and perhaps even completely cured, with healthy lifestyle changes (weight loss, exercise, cutting down on alcohol, and a balanced diet).
- If you have any doubts about this, be sure to see your doctor for advice.
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