Shannan Tujios, M.D. Answers Questions On: Fatty Liver Disease

Fatty liver disease (“fatty liver”) is exactly what it sounds like: excess fat in the cells that make up the liver. We typically diagnose the condition when fat makes up more than 5 to 10 percent of the liver’s weight.

It’s now the most common cause of chronic liver disease in the U.S., and it may or may not be related to alcohol consumption.

Virtually all heavy alcohol drinkers will develop fatty liver disease, with 10 to 20 percent eventually developing cirrhosis. In order to minimize your risk of alcohol-related liver disease, limit yourself to moderate drinking, defined as up to one drink a day for women and two drinks a day for men. A drink is considered 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.

We can usually see fat in the liver with abdominal imaging. In addition, people with fatty liver typically have elevated liver enzymes, which is found with blood work.

About 30 percent of the U.S. population is considered to be obese. Of the people who are overweight or obese, a percentage have non-alcoholic fatty liver disease. In fact, an estimated 20 to 30 percent of adult Americans and up to 10 percent of American children are estimated to have NAFLD.

We think of the course of non-alcoholic fatty liver disease as a continuum. The condition begins as steatosis, which means there's fat in the liver but no inflammation. Up to 30 percent of patients with liver steatosis go on to develop liver inflammation, also known as non-alcoholic steatohepatitis (NASH). About 20 percent of patients with NASH go on to develop liver cirrhosis (scarring).

We’re trying to understand why some overweight patients have no fat in the liver, why some patients with fat in the liver don't develop NASH, and why only a small percentage of those with NASH develop cirrhosis. Work by UT Southwestern’s Helen Hobbs suggests that genetic factors may influence why some people are more susceptible to disease progression than others.

Patients who aren’t obese can have fatty liver disease as well. NAFLD is associated with metabolic syndrome, which we tend to see in people who have things like insulin resistance, elevated triglycerides, increased abdominal fat, and high blood pressure.

There are currently no FDA-approved drugs for fatty liver disease, and that’s a big area of research. The first line of treatment for non-alcoholic fatty liver disease in overweight patients is weight loss. We usually tell patients to aim for a 10 percent weight loss, but even people who lose 3 to 5 percent of their body weight show improvement.

Helping people modify what they eat, decrease total calories, cut down on high glycemic-index foods, and better control their diabetes can really help. I tell my patients that a heart-healthy diet is basically a liver-healthy diet, so the more lean proteins and fresh fruit and vegetables – and the least processed foods – the better.

We’ve had good success in some patients by prescribing cholesterol-lowering statins and medications to help them decrease hunger and manage insulin resistance and other related conditions. I also sometimes recommend a vitamin E supplement to non-diabetic patients, and fish oil or omega-3 fatty acids to patients with high triglyceride levels. We also encourage people with alcohol-related fatty liver to abstain from alcohol.