What does it mean if I have a fatty liver, and how dangerous is that for my health?

Fatty liver is a common disorder where there is accumulation of excess fat in the liver. In people who drink little or no alcohol, this is called NAFLD or Non Alcoholic Fatty Liver Disease. This condition is usually not serious, and the fat does not damage the liver.

However, a small group of people with NAFLD may develop a more serious condition called NASH or Non Alcoholic Steato Hepatitis. In this condition, the fat accumulation results in liver damage and scarring.

Over time, the liver may sustain substantial damage such that functioning liver cells are replaced by non functioning scar tissue, resulting in liver cirrhosis. Liver cirrhosis can lead to liver failure and cancer.

Fatty liver is common, and is present in 10-30% of people. NASH is uncommon, and present in only 2-5% of people with fatty liver, but increases up to 20% if a person is obese. The key is to identify the fatty liver patients who have NASH, as NASH patients will benefit from long term follow up and treatment to prevent cirrhosis and cancer.

This differentiation may not be easy, and usually requires a doctor's assessment. I usually encourage people to check with the doctor that made the diagnosis of fatty liver.

Sincerely,

There is a common misconception that fatty liver occurs only in people who drinks or are overweight. In fact, fatty liver can occur in people who are well and this condition is usually picked up from an unrelated ultrasound liver scan or blood test.

Most people with fatty liver are healthy and asymptomatic but some 20% may progress to liver hardening years down stream. The problem is thought to be related to abnormality in the handling of fats by the liver cells which may happen to people with diabetes, hypertension, high cholesterol or people who are overweight.

It is worthwhile to note that fatty liver is reversible while liver hardening marks a stage of permanent liver damage which should be avoided. Simple measures such as exercise and weight reduction of 5-10% can help in fatty liver.

Other targets to work on include maintaining a good control on diabetes, blood pressure and blood lipids. There is some suggestion that drinking coffee may help with fatty liver. Lastly, consider monitoring your liver enzymes regularly at your doctor's clinic. At times, medicine may help especially in lowering the abnormal liver enzymes associated with fatty liver.

- Dr Quan