From the Guidelines
Fatty liver disease often presents without symptoms in its early stages, making it a silent condition, and when symptoms do occur, they may include fatigue, pain or discomfort in the upper right abdomen, and a feeling of fullness, as noted in recent guidelines 1.
Presentation and Diagnosis
When symptoms are present, physical examination might reveal an enlarged liver (hepatomegaly) and, in advanced cases, signs of liver dysfunction such as jaundice, spider angiomas, or palmar erythema. Laboratory findings typically show elevated liver enzymes (ALT and AST), while imaging studies like ultrasound, CT, or MRI can confirm liver steatosis by revealing increased echogenicity or decreased attenuation.
Risk Factors and Disease Spectrum
Risk factors include obesity, diabetes, high cholesterol, excessive alcohol consumption, and certain medications. The disease exists in two main forms: alcoholic fatty liver disease (AFLD) related to alcohol consumption and non-alcoholic fatty liver disease (NAFLD) associated with metabolic factors, with the latter being referred to as metabolic dysfunction-associated steatotic liver disease (MASLD) in recent clinical practice guidelines 1.
Disease Progression and Importance of Early Detection
If left untreated, fatty liver can progress to inflammation (steatohepatitis), fibrosis, cirrhosis, and even liver failure or cancer, making early detection important despite its often asymptomatic presentation, as highlighted in a comprehensive medical evaluation and assessment of comorbidities standards of care in diabetes-2024 1.
Recent Guidelines and Recommendations
Recent guidelines emphasize the importance of case-finding strategies for MASLD with liver fibrosis, using non-invasive tests, in individuals with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis, particularly in the presence of type 2 diabetes or obesity with additional metabolic risk factors 1.
- Key considerations in the management of MASLD include lifestyle modification, optimal management of comorbidities, and the potential use of targeted treatments for non-cirrhotic MASH with significant liver fibrosis, as recommended in the EASL–EASD–EASO guideline 1.
- The quality standards for the management of NAFLD also emphasize the need for a standardized management approach to reduce variability in care and improve outcomes for patients with NAFLD, as discussed in a consensus recommendation from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD special interest group 1.
From the Research
Presentation of Fatty Liver
Fatty liver, also known as non-alcoholic fatty liver disease (NAFLD), can present in various ways, including:
- Asymptomatic: Many patients with NAFLD are asymptomatic, and the disease is often discovered incidentally on imaging studies such as abdominal ultrasound or CT scans 2, 3.
- Elevated liver enzymes: Patients with NAFLD may have elevated liver enzymes, such as alanine aminotransferase (ALT), which can prompt further evaluation 2, 3.
- Hepatic steatosis on imaging: NAFLD can be diagnosed on imaging studies, such as ultrasound or CT scans, which show hepatic steatosis (fatty infiltration of the liver) 2, 3.
- Metabolic disorders: NAFLD is closely associated with metabolic disorders, including central obesity, dyslipidaemia, hypertension, hyperglycaemia, and persistent abnormalities of liver function tests 4.
Spectrum of Fatty Liver Disease
NAFLD exists on a spectrum of disease, ranging from:
- Simple steatosis: Characterized by fatty infiltration of the liver without inflammation or fibrosis 2, 3.
- Non-alcoholic steatohepatitis (NASH): Characterized by fatty infiltration of the liver with inflammation and fibrosis 4, 2, 3.
- Advanced fibrosis: Characterized by significant scarring of the liver, which can lead to cirrhosis and liver failure 4, 2, 3.
- Cirrhosis: Characterized by extensive scarring of the liver, which can lead to liver failure and other complications 4, 2, 3.
Diagnosis of Fatty Liver Disease
The diagnosis of NAFLD is typically made using a combination of:
- Imaging studies: Such as ultrasound or CT scans, which show hepatic steatosis 2, 3.
- Liver biopsy: Which is the gold standard for diagnosing NAFLD and distinguishing between simple steatosis and NASH 4, 2, 3.
- Biochemical tests: Such as liver function tests, which can show elevated liver enzymes and other abnormalities 4, 2, 3.