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Fatty liver disease

Fatty liver disease is a term for conditions where fat builds up in the cells of your liver. It can be caused by drinking too much alcohol or it may be unrelated to alcohol. Non-alcoholic fatty liver disease is most often a result of being overweight, and is particularly common in men and people with diabetes. Fatty liver disease can sometimes lead to serious liver problems, such as liver cancer and cirrhosis.

If your liver is healthy, there should be little or no fat in it. However, sometimes, fat molecules called triglycerides begin to collect in your liver cells. Small amounts of fat in your liver usually cause no problems. However, when too much fat builds up, this is called fatty liver disease.

There are two main types of fatty liver disease.

  • Alcoholic liver disease, which is caused by drinking too much alcohol.
  • Non-alcoholic fatty liver disease, which is caused by other conditions, such as diabetes or being overweight.

Fatty liver disease is becoming one of the most common types of liver disease and can sometimes lead to serious health problems. It’s now as common as alcohol as a cause of liver cirrhosis. Around one in three people are thought to have some degree of non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is more common in men than in women, and is more likely to be diagnosed in people with diabetes and those over 50.

Fatty liver disease can lead to an inflamed liver and scarring. This is called alcoholic hepatitis if it’s caused by drinking too much alcohol and non-alcoholic steatohepatitis (NASH) if it’s not related to alcohol. Both of these conditions can eventually lead to cirrhosis, which can be life-threatening. Fatty liver disease can also lead to liver cancer.

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Details

  • Symptoms Symptoms of fatty liver disease

    Fatty liver disease often has no symptoms, particularly when it’s mild. However, you may feel tired, or have pain and discomfort where your liver is – on the right side of your body just under your ribs. This pain is caused by a growing amount of fat inside your liver, which makes it expand, stretching the sensitive membrane that covers your liver.

    As fatty liver disease progresses, your liver may become scarred and develop cirrhosis. If you develop cirrhosis, you may notice other symptoms such as:

    • a swollen abdomen (tummy)
    • itchy skin
    • vomiting and bringing up or passing blood
    • bruising easily
    • confusion or poor memory
    • weakness and muscle wasting
    • yellow whites of your eyes and skin (jaundice)

    If you develop any of these symptoms, contact your GP straight away.

    Bupa Health Assesment: Liver check

    If you are concerned about liver disease, Bupa can help you get a diagnosis.

  • Diagnosis Diagnosis of fatty liver disease

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. It’s important to be honest about your lifestyle and the amount of alcohol you drink, as this will help your GP make the right diagnosis. Fatty liver disease can sometimes be difficult to diagnose because you may not have any symptoms.

    Your GP may ask you to have a blood test to check how well your liver is working. You may have other blood tests to find the cause of your symptoms or to rule out other possible causes.

    You may be referred to a hepatologist, a doctor who specialises in conditions affecting your liver. There is no single test that can be used to diagnose fatty liver disease, but he or she may carry out some of the tests listed below.

    • Ultrasound or scan. An ultrasound, CT scan or MRI scan can all be used to create images of your liver. These images will show any fat in your liver.
    • Fibroscan. This is similar to an ultrasound scan – it can help to show any scarring of your liver.
    • Liver biopsy. This is the only way to confirm how much damage there is to your liver. A biopsy is a small sample of tissue. It’s taken using a very fine hollow needle that is inserted into your liver under local anaesthetic. The sample is then sent to a laboratory for analysis.
  • Treatment Treatment of fatty liver disease

    If you have alcoholic liver disease, it’s essential that you stop drinking alcohol. If you don’t stop drinking alcohol, fatty liver disease can develop into alcoholic hepatitis and then cirrhosis in the future. If you stop drinking, it’s likely that your liver will recover from fatty liver disease and hepatitis. To make sure you get the right support to help you to stop drinking, talk to your GP.

    If you have non-alcoholic liver disease, there is no specific treatment for it. However, making changes to your lifestyle can help to reduce the amount of fat in your liver. Losing excess weight, increasing the amount of activity you do and treating other conditions, such as diabetes and high cholesterol, can all help to reduce the amount of fat in your liver.

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  • Causes Causes of fatty liver disease

    There are a number of things that can cause fatty liver disease. The two main ones are:

    • drinking too much alcohol
    • being overweight or obese – this makes it more likely that you will develop conditions such as diabetes or high cholesterol, both of which can also cause fatty liver disease

    There are other things that can cause fatty liver disease, including some medicines and rapid weight loss, but these are less common.

    Acute fatty liver disease is a very rare complication that can develop during the last three months of pregnancy. It can lead to liver failure if it’s not treated quickly. If you’re pregnant and develop symptoms such as abdominal pain, being sick and yellow whites of your eyes and skin, you should contact your GP straight away.

  • Complications Complications of fatty liver disease

    There are several different stages of fatty liver disease. The first stage is where fat builds up in your liver without any inflammation or scarring. For many people, the condition won’t get any worse than this and a serious liver condition won’t develop.

    However, for some people, the build-up of fat causes inflammation. Around one in 20 people who develop an inflamed liver as a result of fatty liver disease will go on to develop serious liver problems, such as cirrhosis, liver cancer or liver failure. All of these conditions are life-threatening.

    If you develop cirrhosis, even with treatment, your liver is unlikely to return to normal. However, treatment can prevent the condition from getting worse.

  • Prevention Preventing non-alcoholic fatty liver disease

    You may be able to prevent non-alcoholic fatty liver disease by:

    • maintaining a healthy weight for your height
    • being active – try to do at least 150 minutes of moderate exercise each week, in bouts of 10 minutes or more
    • eating healthy foods that are low in saturated fat

    It’s not possible to be precise about how much is safe for individual men and women to drink. Current guidelines, however, recommend not regularly drinking more than three or four units a day for men, and two or three units a day for women. Although ‘Regularly’ means every day or most days of the week, it’s a good idea to have at least two alcohol-free days a week so you don’t go over the limits. So over a week, men shouldn’t have more than 21 units and women shouldn’t have more than 14 units. 

    This doesn’t mean you can save up all the ‘allowance’ for a weekend binge. A drinking binge is generally defined as drinking double the daily recommended units in one session.

    A unit of alcohol varies, depending on the strength of what you’re drinking. However, one unit is about 25ml of spirit, half a 175ml glass of wine or half a pint of average strength beer, lager or cider.

  • FAQs FAQs

    Can I drink alcohol if I have non-alcoholic fatty liver disease?

    Answer

    If you have mild non-alcoholic liver disease without any inflammation of your liver, you may be able to drink small amounts of alcohol occasionally. Ask your doctor for advice.

    Explanation

    Drinking alcohol can increase the amount of fat in your liver, and can therefore make existing fatty liver disease worse.

    It’s not possible to be precise about how much is safe for individual men and women to drink. Current guidelines, however, recommend not regularly drinking more than three or four units a day for men, and two or three units a day for women. Although ‘Regularly’ means every day or most days of the week, it’s a good idea to have at least two alcohol-free days a week so you don’t go over the limits. So over a week, men shouldn’t have more than 21 units and women shouldn’t have more than 14 units. This doesn’t mean you can save up all the ‘allowance’ for a weekend binge.

    My liver function tests were ‘abnormal’. What does that mean and should I be worried?

    Answer

    Abnormal liver function tests aren’t uncommon and don’t always mean you have a serious liver condition. Talk to your doctor for more information.

    Explanation

    Liver function tests are blood tests. A sample of your blood is taken and sent to a laboratory where a number of different tests are carried out on it. Liver function tests are done to help your doctor see whether your liver is inflamed or damaged, and whether it’s working properly.

    When the results are sent back to your doctor, the laboratory will give your results along with a normal or reference value. This shows your doctor whether your test results are within the normal range. If your test is abnormal, it means that your results are either higher or lower than the normal range for the test.

    Abnormal liver function tests aren’t uncommon and don’t necessarily mean that you have serious liver problems. Some of the tests are not very specific and an abnormal test can be due to other conditions, not just liver disease.

    Liver function tests can be affected if you have had a recent viral infection, or if you have used drugs or have recently had a lot of alcohol to drink. Your doctor will use the results of your blood test alongside other tests, such as an ultrasound, to find out if you have fatty liver disease.

    If you have had an abnormal liver function test, talk to your doctor for more information about what it might mean.

    What should I eat if I have been diagnosed with non-alcoholic fatty liver disease?

    Answer

    You can reduce the amount of fat in your liver by eating a healthy diet, which is low in saturated fat.

    Explanation

    Some of the fat that builds up in your liver comes from the foods that you eat. Therefore, choosing low-fat foods and eating a healthy, balanced diet can help you to stay healthy. A healthy diet combined with an active lifestyle can help you to lose any excess weight, which will also help to reduce the amount of fat in your liver.

    A balanced, healthy diet is made up of:

    • fruit and vegetables – ideally at least five portions a day
    • starchy foods – for example, wholegrain bread, rice and pasta, and potatoes
    • low-fat protein – for example, beans, fish, lean meat, eggs and low-fat dairy foods
    • only a small amount of food and drinks that contain a lot of fat and/or sugar

    As well as changing some of the foods you eat, you can reduce your weight and the amount of fat in your liver by being more active. You should aim to do some physical activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more.

  • Resources Resources

    Further information

    Sources

    • Non-alcohol related fatty liver disease. British Liver Trust. www.britishlivertrust.org.uk, accessed 5 February 2013
    • Nonalcoholic steatohepatitis. National Digestive Diseases Information Clearinghouse (NDDIC). www.digestive.niddk.nih.gov, published April 2012
    • NASH and non-alcoholic fatty liver disease. British Society of Gastroenterology. www.bsg.org.uk, accessed 5 February 2013
    • Anstee Q, McPherson S, Day C. How big a problem is non-alcoholic fatty liver disease? BMJ 2011;343:d3897. www.bmj.com
    • Cirrhosis. British Liver Trust. britishlivertrust.org.uk, accessed 5 February 2013
    • Fatty liver. eMedicine. emedicine.medscape.com, published August 2012
    • Acute fatty liver of pregnancy. British Liver Trust. www.britishlivertrust.org.uk, accessed 5 February 2013
    • Alcohol. British Liver Trust. www.britishlivertrust.org.uk, accessed 5 February 2013
    • Chalasani N, Younossi Z, Lavine J. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the study of liver diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012; 55(6):2005–23
    • What is a unit? Cancer Research UK. www.cancerresearchuk.org, published February 2013
    • Personal communication, Mr Stephen Pollard, Consultant General Surgeon, Spire Leeds Hospital, 17 February 2013
    • Healthy eating. British Heart Foundation. www.bhf.org.uk, accessed 5 February 2013
    • Liver function tests. Lab Tests Online. www.labtestsonline.org.uk, published October 2012
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 428
    • Alcohol guidelines. House of Commons Science and Technology Committee, www.publications.parliament.uk, published 7 December 2011
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    Produced by Alice Rossiter, Bupa Health Information Team, April 2013.

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