Nonalcoholic Fatty Liver Disease (NAFLD) & NASH

Gastroenterology Hospital in Delhi

You Have A Fatty Liver !! Help !!

Non-Alcoholic Fatty Liver Disease (NAFLD) and Non–Alcoholic steatohepatitis (NASH) is increasingly being diagnosed. Deposition of fat in obese or even non-obese individuals leads to  “fatty liver “ often diagnosed on routine ultrasound or imaging. In individuals who do not take alcohol or minimal amount of alcohol, the term NAFLD/NASH is increasingly being used to differentiate from individuals who take alcohol. 

Today, NAFLD is quite a common diagnosis and usually, patients are asymptomatic and ordinarily do not develop any complications. However, due to a multitude of factors inflammation and scarring develops in these patients with NAFLD. This more serious form of NAFLD is termed NASH. At its most severe, NAFLD can progress to liver failure. 

Non-alcoholic fatty liver is now the most common cause of liver disorder in the USA and Western industrialized countries. NASH is diagnosed in 3-5% of the US population on liver biopsy. NASH occurs more commonly in women and generally between 40-60 years of age however it can occur in males too and beyond this age group too. 

Fatty liver is the accumulation of triglycerides and other fats in the liver cells. The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal. In some patients, fatty liver may be accompanied by hepatic inflammation and liver cell death (steatohepatitis). The pathways implicated in the development of fatty liver include dysfunction of mitochondria, increased synthesis of fats in the body or increased delivery of fats to the Liver. 

However that being said, there is no clear aetiology that has been implicated in the development of  NAFLD/NASH. The condition most commonly associated with fatty liver disease is metabolic syndrome, a constellation of type II diabetes, obesity and hypertriglyceridemia. Other factors also implicated are drugs( Amiodarone, Tamoxifen, Methotrexate, steroids, synthetic estrogens), alcohol,  metabolic disease( galactosemia, glycogen storage disease, homocystinuria, tyrosinemia etc),  nutritional status (overnutrition, severe malnutrition, total parenteral nutrition etc), celiac sprue,  Wilson disease etc. 

More than 70% of the patients with NASH are obese with roughly 10-40% of weight above the ideal body weight. Diabetes is seen in up to 75% of individuals with NASH. High blood triglyceride levels with or without high Cholesterol levels ( seen in routine lipid profile) termed hyperlipidemia is seen in 20-80% of the patients. Insulin resistance is a condition seen in obese individuals with hyperlipidemia and is frequently seen in NASH. 

NAFLD may be found in up to 80% of obese individuals and up to 50% of patients undergoing bariatric surgery. Non-alcoholic fatty liver disease usually causes no signs and symptoms. When it  does, they may include: Fatigue, Pain in the upper right abdomen, Weight loss 

Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. 

Forms Include: 

Non-alcoholic fatty liver: It's not normal for fat to build up in your liver, but it won't necessarily hurt you. In its simplest form, nonalcoholic fatty liver disease can cause excess liver fat, but no complications. This condition is thought to be very common and generally benign. The liver functions normally and microscopically are normal except for fat accumulation within cells. Usually diagnosed when an ultrasound examination of the abdomen is done for an unrelated cause. Liver enzymes (AST/ALT  or SGOT/SGPT ) may be mildly elevated. If AST/ALT or SGOT/SGPT are elevated to more than three times the normal or if a patient has evident jaundice, a liver biopsy may be indicated to look for  NASH or any other liver problem. Patients with fatty liver need no other treatment other than losing weight, control of diabetes and control of lipid levels. Vaccination against Hepatitis A and Hepatitis  B should be considered if not already done. 

Non-alcoholic steatohepatitis: In a small number of people with fatty liver, the fat causes inflammation in the liver and accumulation of fibrous(scar) tissue in the liver. This can impair the liver's ability to function and lead to scarring of the liver (cirrhosis). Liver enzymes are usually more elevated ( more than three times the normal limits) than in NAFLD. Treatment for NASH remains losing weight,  control of diabetes and control of lipid levels. 

Vaccination against Hepatitis A and Hepatitis B should be considered if not already done. Moderate coffee consumption may be beneficial as may be Vitamin E, however, evidence is not strong enough for either of them. 

Nonalcoholic fatty liver disease-associated cirrhosis: Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (liver failure). About 8-26% of the patient with NASH will develop Cirrhosis. In another cohort of NASH, 3%  improved, 54% remained stable and 43 % had progression of NASH. 

Your risk of NAFLD is increased with the following associated conditions gastric bypass surgery,  polycystic ovary syndrome, sleep apnea, Type 2 diabetes, Underactive thyroid (hypothyroidism), and Underactive pituitary gland (hypopituitarism). 

Investigation usually advised towards the diagnosis of NAFLD include Liver function tests,  ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), liver biopsy, and upper gastrointestinal endoscopy. Liver biopsy is typically done using a long needle inserted through your skin and into your liver to remove liver cells (needle biopsy). 

No standard treatment for nonalcoholic fatty liver disease exists. Recommendations include losing weight through regular exercise and diet, vaccinations against Hepatitis A and Hepatitis B, eating a  healthy diet that's rich in fruits, vegetables and whole grains, controlling your diabetes, lowering your cholesterol, and protecting your liver by avoiding alcohol and other liver-damaging drugs.  For fatty liver treatment in Delhi visit Manipal Hospital, which is considered one of the best gastroenterology hospital in Delhi, equipped with the latest technologies and equipment to take care of all your needs. The gastroenterologists in Delhi at Manipal Hospital ​​are experts in many laparoscopic and bariatric surgeries and are recognized for performing complex surgeries with excellent outcomes. 

 

Dr. Sandeep K.Jha 

Consultant - HPB Surgery & Liver Transplant, Manipal Hospital 

Manipal Hospital, Dwarka, Delhi

 

 

 

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