Articles
Fatty Liver
What is fatty liver? Fatty liver is a condition where the liver cells build up more fat than usual. The fat droplets can easily be seen when a small piece of liver tissue from a liver biopsy is examined with a microscope. In its simplest form (steatosis) the liver cells do not appear to be damaged. When there is some inflammation the condition is referred to as steatohepatitis. Where more serious damage has occurred scar tissue develops (cirrhosis) and the liver becomes less able to carry out its vital functions. A recent presentation on Fatty Liver is also available for download in PDF format (Note the file size is around 800kb so this is not recommended for download if you have a slow connection). Causes of fatty liver The liver is the most important organ in the body, being involved in the regulation of many processes. Among these, it manages the use of fats by the body. The normal activity of liver cells can become impaired by a variety of factors so that they allow abnormal amounts of fat to accumulate in them. Factors that damage the liver cells so that they store too much fat include exposure to certain drugs and certain other chemical compounds, some infectious agents, several nutritional situations, and some hormonal, autoimmune and genetic disorders. The most common chemical cause of fatty liver is alcohol. Often there is some inflammation as well, a condition known as alcoholic steatohepatitis. If fatty liver with inflammation is not caused by alcohol then it is referred to as non-alcoholic steatohepatitis (NASH). In most cases NASH is found in obese people. Nutritional causes include starvation and protein malnutrition, excessive dieting, obesity and even intestinal bypass surgery for obesity. The most common hormonal cause of fatty liver is diabetes mellitus since insulin plays an important part in regulating the functions of the liver. Increasingly it is being recognised that the metabolic changes associated with a condition known as insulin resistance can impair the way in which the liver cells metabolise and regulate fats and related substances such as cholesterol. The collection of abnormalities that result from insulin resistance is often referred to as Syndrome X. This syndrome is common in Type 2 diabetics. There is also a rare pregnancy-related hormonal type of fatty liver that can have serious consequences. Eating fatty food by itself does not appear to lead to fatty liver although a high fat diet can result in obesity and elevated cholesterol. Diagnosis of fatty liver Where a patient has a history of exposure to known agents that are toxic to the liver or is otherwise at high risk of liver disease then there is a need to determine if liver damaged is present. In contrast, there are usually no symptoms of simple fatty liver or of NASH. However anyone who is obese should be investigated. This will commonly include people who are Type 2 diabetics or those with unexplained elevated liver enzymes or hyperlipidaemia. Non-invasive investigations can include a physical examination that is likely to reveal an enlarged liver with or without some tenderness when the upper abdomen is pressed. However this is not always found. An ultrasound or abdominal CT scan may also be carried out to assess the appearance of the liver. Blood tests for liver function may be carried out and are likely to show increased levels of the liver enzymes, aminotransferases. Often this result is the only abnormality found. Sometimes the level of triglycerides or cholesterol is also elevated. A liver biopsy may be required to confirm the presence of excess fat in the liver cells and to show any anatomical evidence of more serious damage such as cirrhosis. Treatment of fatty liver Treatment aims to reduce the amount of fat in the liver cells to prevent further liver damage. As the liver is compromised, high fat foods, alcohol and sugar are difficult to metabolise. The type of treatment depends on the cause and may require one or more of the following: Avoidance of any drugs known to be causative agents Avoidance of excess alcohol Treatment of any infections Improvement of the nutritional quality of the diet Improved control of diabetes mellitus through diet, and/or drugs and/or insulin Improved control of hyperlipidaemia through diet and/or drugs Weight loss through reduction of fat especially saturated fat and sugar Prognosis Appropriate treatment can reduce the amount of fat in the liver cells. For many people this will require on going weight control. The long-term picture depends on the extent of the condition when it is first diagnosed. The less damage to the liver, the better the outcome. If untreated, deterioration of the liver cells will continue and the condition can progress to liver failure. Diet and fatty liver Dietary treatment is important for: Improved nutritional status Weight loss Diabetes control Control of hyperlipidaemia The diet most suitable for the treatment of fatty liver will depend on the problems to be treated, but is frequently as follows: Reducing kilojoules for weight loss and reducing insulin resistance Reducing total fat, especially saturated fat, to help with reducing weight, cholesterol and insulin resistance. Limiting high GI foods and sugars to assist in controlling blood glucose and triglycerides Controlling low GI foods to assist in weight loss and in reducing insulin resistance. Evenly spreading intake of carbohydrates to assist in controlling of blood glucose Increasing fibre to improve blood lipids Increasing foods high in antioxidants to aid in liver regeneration. Limiting alcohol to help prevent further damage to liver cells and assist with weight control, diabetes and high blood triglycerides. Some people may need to avoid alcohol entirely. Incorporating more fish and fish oil in the diet to increase the omega 3’s, that may help in boasting the body’s immune response and lowing the triglycerides. Increasing exercise to assist with losing weight and contributing to improving blood glucose and blood fat levels.
Added to site on : Tuesday, 28 December 2010