From the Guidelines
Yes, fatty liver disease is harmful and can lead to serious health complications if left untreated. It occurs when excess fat builds up in liver cells and comes in two main forms: non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease. In its early stages, fatty liver may cause no symptoms, but as it progresses, it can lead to inflammation, scarring (fibrosis), and eventually cirrhosis or liver failure. It also increases the risk of liver cancer and cardiovascular disease 1.
Key Points to Consider
- Fatty liver disease can progress to more severe forms, such as non-alcoholic steatohepatitis (NASH), which significantly increases the risk of cirrhosis and its complications, including portal hypertensive bleeding, hepatocellular carcinoma, and hepatic decompensation 1.
- The disease is harmful because the accumulated fat triggers inflammatory responses and oxidative stress in the liver, damaging liver cells and impairing liver function over time.
- Treatment typically involves lifestyle modifications, including weight loss through a balanced diet and regular exercise, limiting alcohol consumption, and managing underlying conditions like diabetes or high cholesterol.
- For non-alcoholic steatohepatitis (NASH), medications like vitamin E, pioglitazone, or newer agents targeting inflammation and fibrosis may be prescribed, with recent guidelines suggesting the use of resmetirom for adults with non-cirrhotic MASH and significant liver fibrosis 1.
- Regular monitoring through blood tests and imaging is important for people with fatty liver disease to track progression and adjust treatment as needed.
Recent Guidelines and Recommendations
- The most recent guidelines from 2024 recommend a stepwise approach using blood-based scores and imaging techniques to rule out advanced fibrosis, which is predictive of liver-related outcomes 1.
- Lifestyle modification, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption, as well as optimal management of comorbidities, is advised for adults with metabolic dysfunction-associated steatotic liver disease (MASLD) 1.
- Bariatric surgery is also an option in individuals with MASLD and obesity, highlighting the importance of a multidisciplinary approach to managing fatty liver disease.
From the Research
Fatty Liver Disease Overview
- Fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD), is a common long-lasting liver disease that affects millions of people worldwide 2.
- It is characterized by a hepatic fat build-up that can lead to inflammation and damage.
- The disease is closely associated with obesity, insulin resistance, and dyslipidaemia, and is the most common cause of chronic liver disease worldwide 3.
Health Risks and Complications
- Fatty liver disease can lead to serious health complications, including liver morbidity and mortality, cardiovascular disease, and diabetes outcomes 2.
- Cardiovascular disease is the main cause of mortality in patients with NAFLD, followed by extra-hepatic cancers and then liver-specific complications of cirrhosis and hepatocellular carcinoma 4.
- A minority of patients with NAFLD will develop fibrosis and liver-related complications, but it is essential to identify patients with advanced disease using non-invasive markers of fibrosis 5.
Management and Treatment
- Lifestyle modification, including weight loss through dietary modification and exercise, remains the primary intervention in NAFLD 4, 6.
- Nutrition plays a vital role in managing the disease, and a diet rich in whole vegetables, fruits, foods, healthy fats, lean proteins, and specific nutrients can improve insulin resistance and reduce inflammation 2.
- Current drug therapy is limited, but several agents are under development, and novel antihyperglycemic agents, anti-hyperlipidemic drugs, and exercise therapies may be beneficial in managing the disease 2, 4, 6.