Fatty Liver (cont.)
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- Nonalcoholic fatty liver facts
- What are nonalcoholic fatty liver disease and steatohepatitis?
- Why is nonalcoholic fatty liver disease important?
- What causes nonalcoholic fatty liver disease?
- What is the difference between nonalcoholic fatty liver and steatohepatitis?
- What is the relationship between nonalcoholic fatty liver disease, obesity, and diabetes?
- What is the relationship between nonalcoholic fatty liver disease and the metabolic syndrome?
- What are the symptoms of fatty liver?
- How is nonalcoholic fatty liver disease diagnosed?
- What are the other causes of fatty liver?
- What are the complications of nonalcoholic fatty liver disease?
- How is nonalcoholic fatty liver disease treated?
- Weight loss and exercise
- Diet
- Medications and other treatment options
- Bariatric surgery
- Liver transplant
- What is the relationship between nonalcoholic fatty liver disease and cardiovascular disease?
- What diseases are associated with nonalcoholic fatty liver disease?
- Does nonalcoholic fatty liver disease occur in children?
- Find a local Gastroenterologist in your town
What is the difference between nonalcoholic fatty liver and steatohepatitis?
As discussed previously, the difference between isolated, nonalcoholic fatty liver and steatohepatitis (NASH) is the presence of inflammation and damage to the liver cells in NASH; in both, the liver has increased amounts of fat. Although 30% of the general population has fatty liver, approximately 10% have NASH. Approximately 30% of patients with NAFLD have NASH. Although fatty liver and NASH appear to arise under the same conditions, it does not appear that fatty liver progresses to NASH. Thus, whether a patient is to develop fatty liver versus NASH is determined very early during the accumulation of fat, although it is unclear what factors determine this. It is believed that the inflammation and damage of liver cells are caused by the toxic effects of the fatty acids released by fat cells, but fatty acids in the blood are elevated in both fatty liver and NASH. Perhaps the difference is explained by genetic susceptibility as suggested by preliminary data.
The consequences of fat in the liver depend greatly on the presence or absence of inflammation and damage in the liver, i.e., whether there is fat alone or NASH is present. Isolated fatty liver does not progress to important liver disease. NASH, on the other hand, can progress through the formation of scar (fibrous tissue) to cirrhosis. The complications of cirrhosis, primarily gastrointestinal bleeding, liver failure, and liver cancer, then may occur.
What is the relationship between nonalcoholic fatty liver disease, obesity, and diabetes?
As discussed previously, obesity and diabetes have important roles in the development of fatty liver. Whereas 30% of the general population (which includes obese and people with diabetes) may develop NAFLD, more than 75% of people with diabetes develop NAFLD. Among patients who are very obese and undergoing surgery for their obesity, 90% have NAFLD. Moreover, whereas the risk of NASH is less than 5% among lean persons, the risk is 35% among the obese. Fatty liver increases both in prevalence as well as severity as the degree of obesity increases. The increases begin at weights that are considered overweight - i.e., less than obese.
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