What is fatty liver or fatty liver

It is a fairly prevalent disease in developed countries that especially affects men between 40 and 60 years of age. It has an incidence of 15% or 35% depending on the countries and has been increasing in recent decades due to the increase in the presence of type 2 diabetes mellitus and obesity.

What is the fatty liver?

The liver is an organ with several functions, including the production of proteins, the storage of glycogen and the secretion of bile, necessary for the digestion of fatty substances. The main cell of the liver is the hepatocyte, a cell that has the capacity to store both glucose and lipids (fats) inside.

If excess fat accumulates in them, there may come a time when the cells do not perform their function correctly. When this occurs, and the cause of this increase in intracellular lipids is not the consumption of alcohol, it is said that the patient suffers from fatty liver or fatty liver.

How does hepatic steatosis occur?

It is a disease that occurs in healthy livers and is not derived from excessive consumption of alcohol, a clearly hepatotoxic substance. Fats progressively accumulate in hepatocytes due to an excessive production compared to their use, a fact that causes a greater sensitivity to factors that can cause liver damage and, in the long run, lead to inflammation and fibrosis, which prevents the organ from leading to perform their duties properly.

The main factors that predispose or facilitate the occurrence of hepatic steatosis are:

• Obesity.
• and insulin resistance.
• Dyslipidemia
• Arterial hypertension.
• Certain drugs: amiodarone, antiretrovirals, corticosteroids, diltiazem, tamoxifen, etc.
• Various diseases: obstructive sleep apnea syndrome (OSAS), polycystic ovary, significant weight loss, intestinal resection, etc.

Symptoms

In general, hepatic steatosis does not usually cause obvious or bulky signs. Most of the time it is an accidental finding when performing an abdominal imaging test (ultrasound or computerized axial tomography (CT) mainly) for some other reason.

However, in some cases the patient may have a dull pain in the abdomen, in the liver region, be more tired than normal, or notice hepatomegaly, an increase in liver size that is perceived when palpating the abdomen.

Most patients with fatty liver remain stable and the disease only degenerates in one and, residual cases, in liver failure. The coexistence of obesity and type 2 diabetes mellitus favors its progression. Fatty liver patients have been seen to suffer more frequently from cardiovascular complications.

Fatty liver diagnosis

The diagnosis is usually a chance finding. Examination of the patient's abdomen may be unremarkable or the physician may notice an increase in liver size or the patient may report tenderness to the liver region.

In the analysis you can see an elevation of liver enzymes (GOT, GPT and GGT), as well as a decrease in high-density cholesterol (HDL) and an increase in triglycerides, along with high levels of glucose in the blood.

It is the best imaging test due to its simplicity and low invasiveness to assess the findings of hepatic steatosis. CT or magnetic resonance imaging (MRI) can also be helpful in diagnosing fatty liver. However, the definitive diagnosis will be given by liver biopsy, but since this disease generally has a benign course and the test has risks, it is recommended not to perform it unless the patient has risk factors for disease progression, such as they are advanced age, severe obesity, diabetes or a significant alteration of liver enzymes. The study of the tissue will make it possible to assess the degree of inflammation and fibrosis.

It is important to establish the diagnosis to rule out possible causes of hepatitis and liver malfunction beforehand, such as:

• Alcoholic steatosis.
• Use of hepatotoxic drugs.
• Viral hepatitis (HBV, HCV).
• Autoimmune liver disease.
• Hemochromatosis.
• Wilson's disease.

Treatment

Fatty liver is an essentially benign disease and treatment is based on preventing its progression by detecting risk factors as soon as possible and correcting them.

It is advisable that if the patient is overweight or obese, they try to reduce their body mass index (BMI) through a proper diet and moderate aerobic exercise (running, cycling, rowing…).

In the case of diabetes or dyslipidemia, adequate metabolic control and the use of drugs prescribed by the specialist, such as glitazone or biguanide antidiabetic drugs, and antilipemic drugs such as statins, is important.

Precautionary measures

Despite being a benign disease, one should try to prevent it by reducing the consumption of fats and sugars that can lead to obesity and type 2 diabetes mellitus, as well as doing moderate physical activity.

• Fatty liver is a disease derived from the progressive accumulation of fat in the hepatocytes that prevents the organ from carrying out its functions correctly.
• Obesity, type 2 diabetes or hypertension are factors that facilitate the appearance of fatty liver or hepatic steatosis.
• It does not usually cause obvious symptoms, it is usually a casual finding but dull pain in the region of the liver, fatigue or increased liver size in some cases can reveal its appearance.