Fatty liver disease: the most common liver disease

The liver is an important organ. Among other things, it plays a major role in fat metabolism in our body. Due to changes in our diet and lifestyle, this fat metabolism is increasingly disrupted. The result is an accumulation of fats in the liver or fatty liver. The condition occurs in as many as 25 to 40% of adults in the Western world. Fatty liver disease can lead to liver inflammation and eventually even permanent liver damage.

The liver / Source: Henry Vandyke Carter, Wikimedia Commons (Public domain)

The liver is a large organ located in the upper right part of the abdominal cavity, just below the diaphragm. The liver of an average adult person weighs one and a half kilos, making it the heaviest organ in our body after the skin. The liver mainly fulfills important functions in our metabolism. It helps ensure that we can absorb nutrients such as carbohydrates, fats and proteins from the blood and use them for numerous processes. The liver also produces bile, stores iron and plays an important role in neutralizing toxins and cleaning up waste. If the liver cannot perform its functions properly due to inflammation or damage, this can have major consequences for our health.

The function of the liver in fat metabolism

The liver is partly responsible for fat metabolism in our body. Fat metabolism is the process by which our body forms fats (from nutrients absorbed in the intestines) or breaks them down. This process largely takes place in the liver. The liver absorbs the breakdown products of fats (free fatty acids) from the blood and converts them into other fatty substances. These new fats are released into the blood and used by our body. If necessary, the liver can also break down fats into fatty acids and convert saturated fatty acids into unsaturated fatty acids. In addition, the liver produces the fatty substance cholesterol, which we need as a building block for body cells and hormones. Eighty-five percent of all required cholesterol is produced in the liver. We get the rest through our diet. Finally, bile – a thick, bitter, yellow-green fluid produced in the liver – ensures better absorption of fats in the small intestine.

Fatty liver disease is an accumulation of fat in the liver cells

Due to changes in our diet and lifestyle, fat metabolism is increasingly disturbed. The liver is then unable to process the fat breakdown products offered. The result is that fat accumulates in the liver cells. This is called fatty liver disease or steatosis. It is the most common liver disease today; 25 to 40% of adults in the Western world suffer from it. Fatty liver disease is a reversible process. This means that the

The stages of liver damage, starting with fatty liver disease / Source: Countincr, Wikimedia Commons (Public domain)

Fat accumulation disappears as soon as the cause is removed. However, if the cause remains present, the accumulation of fat continues to spread. The liver becomes increasingly sensitive to harmful influences such as viruses, bacteria, toxins and alcohol. In one in five people, fatty liver disease leads to inflammation of the liver (hepatitis) at some point. Ultimately, irreversible damage to the liver can occur, known as cirrhosis. The liver cells are then replaced by scar tissue (connective tissue), making the liver increasingly less able to perform its functions. In the long term, this causes serious complaints and a liver transplant is the only possible treatment.

Complaints of fatty liver disease: vague abdominal pain and fatigue

Fatty liver disease is not always recognized. Many people have little or no complaints. Some people experience vague pain in the upper right abdomen and fatigue. Occasionally jaundice occurs, where the mucous membranes (whites of the eyes, gums) and the skin look yellow, because there is too much bilirubin in the blood. Bilirubin is a waste product with an intense yellow color, which remains after the breakdown of hemoglobin from red blood cells. The bilirubin is transported to the liver via the blood and converted into a water-soluble substance. If the liver is affected, less bilirubin can be processed. The concentration of bilirubin in the blood then remains too high, literally turning you yellow. If the fatty liver has led to liver inflammation, symptoms such as nausea, vomiting, pain in the upper right side of the abdomen, poor appetite, fatigue, fever, itching, jaundice and a swollen abdomen occur.

Alcohol and obesity are the most common causes

In half of the cases, excessive and long-term alcohol consumption is the cause of fatty liver disease. Alcohol is transported to the liver via the blood. More than 90% of the alcohol is broken down here. This process produces breakdown products that are aggressive and harmful to the liver. Chronic excess alcohol can have a devastating effect on the liver. The liver cells are damaged and normal processes in the liver no longer run properly. The production and conversion of nutrients will become less efficient, causing water, proteins and fats to accumulate in the liver cells.
After alcohol abuse, obesity and type 2 diabetes are the most important causes of fatty liver disease. This is called non-alcoholic fatty liver disease (NAFLD). In overweight people, the supply of fat breakdown products to the liver is significantly increased. The liver has insufficient capacity to process these breakdown products, resulting in fat accumulating in the liver. People who have a lot of fat in the abdomen are especially sensitive to this. In people with type 2 diabetes, the body is insensitive to insulin, which causes blood sugar levels to remain too high. The excess sugars are converted into fats in the liver. These are stored in the liver and cause fatty liver disease. This can cause fatty liver disease to develop at a relatively young age. Liver inflammation develops in 20 to 30% of people with non-alcoholic fatty liver disease.
Other, less common causes are: malnutrition (which causes a deficiency of certain proteins), the use of certain medications that need to be broken down in the liver (including cordarone, nifedipine and some corticosteroids) and chronic intestinal inflammation (such as Crohn’s disease). and ulcerative colitis), with fatty liver disease occurring as a complication. A very rare and acute form of fatty liver disease can develop in the last three months of pregnancy (gestational steatosis). This serious form of fatty liver disease can be very dangerous for mother and child. The complaints usually disappear immediately after delivery.
The metabolic syndrome
The so-called metabolic syndrome is a combination of five risk factors that in many cases leads to fatty liver disease:

  1. Increased blood pressure.
  2. A waist circumference of more than 102 cm in men and more than 88 cm in women.
  3. An increased blood sugar level (indicating diabetes).
  4. An increased level of triglycerides (fatty substances) in the blood.
  5. A low HDL cholesterol level, the so-called ‘good cholesterol’.


The diagnosis and treatment of fatty liver disease

Microscopic image of fatty liver disease / Source: Nephron, Wikimedia Commons (CC BY-SA-3.0)

Because fatty liver disease does not always cause symptoms, the condition is often discovered by chance. For example, during a routine (blood) test or a medical examination. If you do have complaints that may indicate fatty liver disease, your doctor will perform a physical examination and blood tests. The liver may be slightly enlarged or tender and blood tests usually reveal slightly elevated liver values. If in doubt, your GP will refer you for further examination. In that case, an ultrasound of the liver is initially performed. The fat accumulation in the liver is generally clearly visible. The diagnosis can be made with certainty – if necessary – through a liver puncture, in which a small amount of tissue is aspirated from the liver.
There is no medicine available to cure fatty liver disease. However, fatty liver disease is a reversible process. The treatment therefore consists of removing the cause. The fat accumulation usually disappears on its own. For many people, this means adjusting their lifestyle and nutritional habits: not drinking alcohol (even when alcohol consumption is not the cause), a healthy and varied diet (low fat) and weight loss. A healthy diet and extra exercise also reduce any insulin resistance. Type 2 diabetes will also need to be treated with medication.
It is important to prevent the spread of fatty liver disease. The fat in the liver in itself (up to a certain extent) is not harmful. However, fatty liver disease does make the liver sensitive to harmful influences. The further the fat accumulation in the liver expands, the greater the risk of inflammation. Inflammation of the liver can eventually lead to liver cirrhosis. This is a serious, irreversible liver disease that can ultimately lead to death.

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