Fatty Liver Disease is a Growing Concern
By Brent Lemberg, MD
Most Americans are aware that
alcoholism and hepatitis C can lead to cirrhosis of the liver, but few people
understand the risk of cirrhosis from fatty liver disease. An estimated 15 to
20 percent of all Americans have some degree of fatty liver disease, making it
the most prevalent liver disease in this country.
Who is at risk for fatty liver
Fatty liver disease is most common
in people who are obese or who have metabolic syndrome, which comprises a group
of risk factors including obesity, diabetes, and high cholesterol. Ninety
percent of all obese patients have fatty liver disease, as do 50 percent of all
What causes fatty liver disease?
Normally, the liver helps to break
down and remove fat, cholesterol, and lipids from the body. However, when a
person becomes seriously overweight and develops insulin resistance, the liver
becomes less efficient and begins to store fat rather than breaking it down.
Stored fat in the liver can lead to inflammation, which in turn can cause
permanent scarring and cirrhosis.
How serious is this problem?
While the majority of cases of
fatty liver disease are fairly benign, about 30 percent of the time, fatty
liver disease advances to a more serious condition known as nonalcoholic
steatohepatitis (NASH). Of those, 10 percent develop cirrhosis. The number of
people facing the risk of cirrhosis is increasing as the incidence of obesity
rises in this country. The Centers for Disease Control (CDC) predict that by
the year 2025, nearly 40 percent of Americans will be obese, including 20-30
percent of American children. This poses a very significant health problem in
What is cirrhosis of the liver?
Cirrhosis is one of the top ten causes
of death by disease in this country. It results from permanent scarring of the
liver, caused by chronic disease or damage. A scarred liver cannot function
properly and is no longer able to filter toxins from the blood or produce
important enzymes and clotting factors. Severe cirrhosis puts you at risk for
liver failure and may require a liver transplant.
How is fatty liver disease
Because there are often no specific
symptoms, fatty liver disease is usually detected when a routine blood chemistry
profile shows elevated liver function. In determining the cause of a person’s
elevated liver function, we check out risk factors for hepatitis, autoimmune
diseases, and medication-induced liver disease. A person in the latter stages
of fatty liver disease may have pain in the right upper quadrant of his or her
abdomen over the liver, and may be experiencing lack of energy and fatigue.
After ruling out other causes of liver disease, the doctor may order an
ultrasound, CT scan, or MRI to look for signs of fat in the liver.
What is the recommended treatment?
There is no quick fix. The optimal
treatment is to lose weight, control diabetes, and lower your cholesterol.
Losing 10 percent of your body weight is often enough to return liver function
back to normal. There is ongoing research for medications to treat fatty liver
disease, and there is some interest in the role of antioxidants, such as
vitamins A and C. However, at this time, the best treatment is weight loss. We
have seen improvement of fatty liver disease in severely obese patients who
have successfully undergone weight-loss (bariatric) surgery, such as gastric
People can and do live for a long
time with fatty liver disease if it does not progress to a serious condition.
Treatment requires lifestyle changes and weight loss, which can be very tough
to achieve. The very best strategy is prevention, which starts by setting a
healthy example for our children.
Lemberg is board-certified in gastroenterology and internal medicine. He is on
the medical staff of Cayuga Medical Center and in practice with
Gastroenterology Associates of Ithaca, where he can be reached at (607)