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Steatotic (Fatty) Liver Disease: Understanding Causes, Symptoms, and Management
Steatotic liver disease (SLD) was once referred to as “fatty liver disease,” but the term “fatty” has been viewed as stigmatizing by some. In 2023, international liver specialists renamed the condition and its subtypes to better reflect its underlying causes. While the liver naturally contains some fat, when fat makes up more than 5% of the liver’s weight, it can lead to liver damage and other health complications.
Steatotic liver disease is becoming increasingly common, particularly as obesity and related conditions like diabetes rise. It is important to understand the different types of steatotic liver disease, its causes, symptoms, and how it can be managed to prevent further liver damage.
Types of Steatotic Liver Disease (SLD)
Steatotic liver disease (SLD) is classified into the following types based on its causes:
1. Metabolic dysfunction-associated steatotic liver disease (MASLD):
– Formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD); MASLD is the new nomenclature and includes patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.
– What Is It?: MASLD occurs when fat builds up in the liver of people who drink little or no alcohol. It is the most common type of fatty liver disease and is often associated with obesity, insulin resistance, type 2 diabetes, and metabolic syndrome.
– Metabolic dysfunction-associated steatohepatitis (MASH): A replacement term for nonalcoholic steatohepatitis (NASH). A more severe form of MASLD, where fat accumulation is accompanied by inflammation and liver cell damage, increasing the risk of cirrhosis and liver cancer.
2. Alcoholic Fatty Liver Disease (AFLD):
– What Is It?: AFLD is caused by heavy alcohol consumption, which leads to fat accumulation in the liver. Continued alcohol use can cause inflammation and damage, progressing to alcoholic hepatitis, fibrosis, and cirrhosis.
– Reversible with Lifestyle Changes: In its early stages, AFLD is often reversible with reduced alcohol consumption and lifestyle changes.
3. MASLD and increased alcohol intake (MetALD):
– What Is It?: MetALD is caused by both metabolic risk factors and alcohol consumption. In MetALD, you have a cardiometabolic risk factor and consume greater amounts of alcohol per week (140 grams per week for females and 210 grams per week for males).
4. Other forms of SLD:
– SLD can result from causes other than alcohol use or cardiometabolic risk factors. For example, various drugs and diseases can cause steatosis.
Causes and Risk Factors
The exact cause of steatotic liver disease is not fully understood, but several factors are known to contribute to its development:
Obesity: Excess body weight, particularly abdominal obesity, is a major risk factor for fatty liver disease.
Insulin Resistance: Conditions like type 2 diabetes and metabolic syndrome, where the body’s cells become resistant to insulin, are closely linked to MASLD.
High Cholesterol and Triglycerides: Elevated levels of these fats in the blood can contribute to fat accumulation in the liver.
Genetic Factors: A family history of fatty liver disease or certain genetic predispositions can increase the risk.
Alcohol Consumption: Excessive alcohol intake is the primary cause of AFLD and can also exacerbate MASLD.
Malnutrition: Rapid weight loss, poor nutrition, and certain eating disorders can lead to steatotic liver.
Medications: Certain medications, such as corticosteroids and some cancer treatments, can cause steatotic liver as a side effect.
Symptoms of Steatotic Liver Disease
Steatotic liver disease is often referred to as a “silent” condition because many people with the disease do not experience symptoms, especially in the early stages. When symptoms do occur, they may include:
Fatigue: Persistent tiredness or lack of energy.
Abdominal Discomfort: Mild pain or discomfort in the upper right side of the abdomen, where the liver is located.
Unexplained Weight Loss: Losing weight without trying, particularly in the later stages of the disease.
Weakness: Generalised weakness or a feeling of being unwell.
In more advanced stages, where liver damage has progressed to cirrhosis, symptoms may include jaundice (yellowing of the skin and whites of the eyes), fluid buildup in the abdomen and legs, and confusion or difficulty thinking clearly.
Diagnosis of Steatotic Liver Disease
Steatotic liver disease is often discovered during routine blood tests or imaging studies done for other reasons. Common diagnostic tools include:
Blood Tests: Elevated liver enzymes (ALT, AST) in the blood may indicate liver inflammation or damage, prompting further investigation.
Imaging Studies: Ultrasound, CT scans, or MRI can reveal fat accumulation in the liver. A specialized ultrasound called transient elastography (FibroScan) can measure liver stiffness, which helps assess the extent of liver damage.
Liver Biopsy: In some cases, a liver biopsy may be needed to confirm the diagnosis and assess the severity of inflammation, fibrosis, or cirrhosis. This involves taking a small sample of liver tissue for microscopic examination.
Management and Treatment of Steatotic Liver Disease
There is currently no specific medication for steatotic liver disease, but the condition can be managed effectively through lifestyle changes and treatment of underlying risk factors. Key management strategies include:
Lifestyle Modifications:
Weight Loss: Gradual weight loss through a healthy diet and regular exercise is one of the most effective ways to reduce liver fat and improve overall liver health. Even a 5-10% reduction in body weight can have a significant impact.
Healthy Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help manage fatty liver disease. Reducing the intake of saturated fats, refined sugars, and processed foods is also important.
Exercise: Regular physical activity, such as brisk walking, swimming, or cycling, can help reduce liver fat, improve insulin sensitivity, and support weight loss.
Alcohol Reduction:
For AFLD: Complete abstinence from alcohol is crucial to prevent further liver damage.
For MASLD: Limiting alcohol consumption is advised, as even moderate alcohol intake can worsen liver damage in people with MASLD.
Managing Underlying Conditions:
Diabetes and Insulin Resistance: Managing blood sugar levels through diet, exercise, and medication can help control fatty liver disease.
High Cholesterol and Triglycerides: Medications such as statins may be prescribed to manage high cholesterol and triglyceride levels.
Regular Monitoring:
Regular Monitoring: People with fatty liver disease should have regular follow-ups with their healthcare provider to monitor liver function, assess the effectiveness of lifestyle changes, and detect any progression of the disease.
Medications:
Medications: While there is no specific drug approved for treating fatty liver disease, some medications may be prescribed to address related conditions, such as insulin-sensitizing drugs, antioxidants, or lipid-lowering agents. Clinical trials are ongoing to develop effective treatments for MASLD and MASH.
Conclusion
Steatotic liver disease is a common but potentially serious condition that can lead to significant liver damage if left untreated. Fortunately, with early detection and appropriate management, it is often possible to reverse or halt the progression of the disease.
If you are at risk for steatotic liver disease or have been diagnosed with it, adopting a healthy lifestyle, managing underlying conditions, and working closely with your healthcare provider can help protect your liver and improve your overall health. Regular monitoring and proactive management are key to preventing complications and maintaining a healthy liver.
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