What is fatty lever?
Fatty liver is an accumulation of fat in the liver. The liver plays an important role in fat metabolism. If something goes wrong in the fat metabolism, the liver can start to store more and more fat in the liver cells. As a result, the liver becomes fat. Fatty liver is also called steatosis.
Fatty liver is the most common liver disease in the western world. Due to an unhealthy diet and lifestyle, the fat metabolism in the body is disrupted and fat accumulates in the abdominal organs, including the liver. The metabolism of the liver also changes, so that more fat ends up in the liver cells.
Fatty liver can (partially) recover if the cause of the fatty liver is removed. If nothing is done, the liver will become more and more fatty. One in five people who have fatty liver for a long time eventually develop inflammation of the liver (hepatitis) . This inflammation can cause scarring of the liver (liver fibrosis) and eventually lead to liver cirrhosis . In liver cirrhosis, there is severe damage to the liver that can eventually lead to liver failure. That can be life-threatening. A liver transplant is then the only treatment option.
The liver is an organ with many different functions. In addition to the production of bile fluid, the liver also stores vitamins and minerals. Many important substances are produced in the liver, such as proteins and fats. In addition, the liver makes toxic substances and medicines harmless and this organ plays an important role in energy management. The liver has a large reserve capacity and a large recovery capacity. If part of the liver is removed, the rest will grow back. A condition for this is that the remaining part of the liver is healthy and large enough.
Due to the large reserve capacity of the liver, liver diseases often only cause problems at a late stage. In an early stage, many people with liver diseases have no complaints. This is because the healthy part of the liver can perform the various functions well enough. The liver is located in the upper right part of the abdominal cavity, against the diaphragm and below the ribs.
In adult humans, the liver weighs about one and a half pounds and is almost the size of a football.
Causes of fatty liver
The most common causes of fatty liver are:
Overweight and obesity
Overweight and obesity lead to more fat in the liver. People with a lot of fat around their waist (belly fat) are especially at risk of fatty liver.
Diabetes Mellitus Type 2 (diabetes)
People with type 2 diabetes are more likely to have fatty liver. Especially if they are not well adjusted to medicines or if they do not exercise enough and eat unhealthy food. Their blood sugar levels are then too high for a longer period of time and the excess sugars are converted into fats in the liver. These fats end up in the liver cells, resulting in fatty liver.
The metabolic syndrome mainly occurs in people with (severe) overweight, obesity and Diabetes Mellitus. People with the metabolic syndrome more often have a disturbed fat metabolism and therefore more likely to develop fatty liver.
The metabolic syndrome is a combination of:
- raised blood pressure
- increased triglycerides in the blood (triglycerides are fats in the blood that provide energy)
- wide waist circumference (>102 cm for men and >88 cm for women)
- low HDL cholesterol and
- elevated blood sugar
All these factors together increase the risk of fatty liver, cardiovascular disease and cancer.
Chronic alcohol use
The level of how much alcohol is already toxic to the liver is very individual for each. It is generally considered safe for men up to 20 g of pure alcohol per day and for women up to 10 g of pure alcohol per day. It is a really small amount of alcohol, just to give you an idea, in 2 dcl of 12% wine there is 19 g of alcohol and in 0.5 l of 12 ° beer there is 20 g of alcohol. Liver damage due to excessive alcohol consumption does not become apparent until advanced disease changes occur.
Less common causes of fatty liver include:
- Malnutrition (deficiency of carbohydrates, fats and proteins)
- Use of some medications that can interfere with liver function.
- Fatty liver disease can also occur as a complication of chronic intestinal inflammation, such as Crohn’s disease and ulcerative colitis . This is especially common when these diseases are treated with the drug Prednisone.
Non-Alcoholic Fatty Liver (NAFLD and NASH)
Fatty liver that is not caused by excessive alcohol consumption is also called non-alcoholic fatty liver . The English name for this is non alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease is common in western countries. Often as a result of an unhealthy lifestyle with little exercise and high-calorie and fatty foods.
NAFLD is a collective name for non-alcoholic liver diseases with fatty liver as an initial stage and liver inflammation (non-alcoholic steato-hepatitis or NASH) as an end stage. This liver inflammation can then lead to liver cirrhosis and liver cancer.
A very rare and acute form of fatty liver can develop during pregnancy and is called gestational steatosis. Gestational steatosis can develop from the 28th week of pregnancy. It is a very serious form of fatty liver that can be very dangerous for both mother and child. The symptoms usually disappear immediately after delivery.
How do I recognise Fatty Liver?
Signs and symptoms in fatty liver
Fatty liver usually causes no symptoms. Some people suffer from (vague) pain in the upper right abdomen and fatigue. Very occasionally there is jaundice . Jaundice is the yellowing of the whites of the eyes and skin.
In 1 in 5 people with fatty liver, inflammation of the liver (hepatitis) develops . Various complaints can occur, including chronic fatigue, a general feeling of illness and sometimes itching.
Diagnosis of fatty liver
Fatty liver is often discovered accidentally during an ultrasound of the upper abdomen or due to abnormal blood values during an examination for other complaints. This is because fatty liver usually gives no or hardly any specific complaints.
If there are complaints that may indicate fatty liver, the general practitioner will do a physical examination and blood tests. On physical examination, the liver may be slightly enlarged or tender, but this is not necessary. Blood tests usually show slightly elevated liver values, but this is not necessary either. If in doubt, the GP will refer you to the hospital for further examination.
During an ultrasound , the liver is visualized using sound waves. If more than 30 percent of the liver is fatty, this can be clearly seen on an ultrasound.
A fibroScan measures the degree of fatty liver and the amount of scar tissue (fibrosis) in the liver. The doctor places an ultrasound head on the abdomen and sends sound waves to the liver with a non-painful push into the skin. It then measures how quickly the sound waves return.
Based on this, the doctor can determine how flexible the liver is. A normal liver is very flexible and weak, a liver with a lot of scar tissue is stiff. If liver damage is detected with a FibroScan, an additional liver puncture may be performed.
(Echo-guided) liver puncture or liver biopsy
A liver puncture is an examination in which the doctor inserts a hollow needle into the liver through the abdominal wall under local anaesthetic. With this he takes a small piece of tissue (biopsy) from the liver.
The biopsy is examined under the microscope. This allows the doctor to determine the extent of liver damage. The correct location of the puncture is often determined with an ultrasound.
Treatment of fatty liver
In most cases, fatty liver can be reversed through lifestyle changes: more exercise, a healthy diet and a healthy weight. If long-term alcohol use has led to fatty liver, alcohol should preferably be stopped completely or at least drastically reduced.
It is advised to stop completely if inflammation in the liver is also visible. Once the cause of the fatty liver is gone, the fat accumulation in the liver often decreases or disappears completely. Any inflammation will also decrease. This allows the liver to recover.
If medication is the cause, you can look together with your doctor for a replacement medication that causes less fat accumulation. If you have diabetes, it is important to use the medicines properly and to live a healthy life to keep your blood sugar levels well regulated.
There is no specific drug that de-fats the liver. A lot of research is being done into new medicines that may be used in the future in the treatment of fatty liver and in the prevention of complications. Your doctor can tell you more about this.
Tips and advice for fatty liver
These advices are also important if this is not the cause of your fatty liver. This way you can prevent further fatty liver and prevent liver inflammation (hepatitis) and ultimately serious liver damage (liver cirrhosis) .
- Eat healthy and varied
- Maintain a healthy weight
- Do not drink alcohol or limit your alcohol consumption
- Get plenty of exercise.