Overview: What is a fatty liver?
If more than 50 percent of the liver cells are affected by fatty degeneration or if the proportion of fat in the liver exceeds ten percent of the total weight, this is referred to as fatty liver. If fatty liver disease is not stopped – by changing lifestyle with a healthy diet and no alcohol, liver inflammation, cirrhosis or even liver cancer may result. In addition to the main risk groups, which include alcohol addicts or severely overweight adults, children and adolescents are also becoming increasingly ill. In Western Europe, about 20 to 40 percent of all adults have fatty liver disease. Around two percent suffer from fatty liver hepatitis.
New modern drug therapies
The University Hospital of Zurich is running several trials testing new modern drug therapies for fatty liver disease.
In addition, the University Hospital Zurich is actively involved in the Swiss Fatty Liver Foundation (Swiss NASH Foundation).
Fatty liver: causes and risk factors
A functioning liver produces bile to digest fat in the intestines, converts excess carbohydrates to fat, or stores them as glycogen to provide energy later. It also breaks down toxins, drug components and alcohol. With this multitude of tasks, it may seem reassuring that the liver has a high regenerative capacity, but extreme, prolonged stress can quickly lead to overload. Even as a healthy person, you should always keep this in mind with your diet, lifestyle and alcohol consumption. In particular, the combination of alcohol consumption and obesity can be a direct path to fatty liver.
An after-work beer, a glass of wine with dinner, a cocktail at a party, a shot to help digestion: alcohol is often a daily indulgence in everyday life. It may be obvious that excessive, frequent consumption is hazardous to health in many areas of the body, psyche and social life. You should be alert to this and, if necessary, seek therapeutic support if you cannot control your consumption yourself. The amount of alcohol tolerated by the body on a daily basis is less than many people believe. Generally, an upper limit of 100g of alcohol per week applies to both women and men today. This is the equivalent of about one deciliter of wine per day or one small beer.
Even if you stick to this amount, it should not be consumed on a daily basis. The liver breaks down alcohol via certain proteins. However, since it also has to complete other cleansing processes, you have to give it breaks every now and then.
In our latitudes, we fortunately have the opportunity to choose from a rich and varied food supply at any time and in any place. It is often difficult to resist the temptations of abundant sugary and fatty foods. However, if the body is supplied with too much energy that it cannot use due to too little exercise, the excess is deposited not only under the skin but also in the liver as fat. This puts additional strain on the liver in addition to its normal functions. It may then no longer be able to fully perform its tasks of breaking down toxins in the body and supporting digestion. Furthermore, fat accumulation in muscles and liver can also lead to diabetes or metabolic syndrome.
Symptoms: Fatty liver
In most sufferers, the liver becomes fatty over a long period of time without them noticing. In addition to obvious risk groups such as alcoholics or overweight people, people who are slim or only slightly overweight can also fall ill. As the size and severity of the liver increases, very nonspecific symptoms may occur:
- Feeling of pressure in the right upper abdomen
- Loss of appetite
- Feeling of fullness
Fatty liver: diagnosis with us
We tend to discover a fatty liver by chance during examinations that we perform for other reasons. The presence of fatty liver disease is indicated by various liver values that are measured during a blood test. These include:
- Gamma-glutamyltransferase (GGT)
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
These values may also indicate already developed fatty liver hepatitis, but there are other diseases that lead to the same changes in liver values. Therefore, further investigations are necessary. For example, an abdominal palpation, ultrasound examination, and magnetic resonance imaging (MRI or MR).
With the ultrasound examination, we obtain the first indications as to whether a fatty liver is present. With MRI, we can take images of the entire liver and accurately measure whether a fatty liver is present and the severity of the fatty condition. In addition, we can perform MRI elastography. In MRI elastography, we use pressure waves to measure how elastic or hardened the liver is. This allows us to draw conclusions about the degree of liver hardening and whether progressive liver damage is already present.
If imaging techniques are not sufficient to make a diagnosis, we perform a liver biopsy, in which we remove a small sample of tissue from the liver through a special needle under local anesthesia.
Fatty liver: prevention, early detection, prognosis
The best prevention against a variety of diseases is a healthy diet and daily exercise – preferably in the fresh air. It is recommended to abstain from alcohol and drugs, to get enough and regular sleep and to lead a mindful lifestyle. To specifically support your liver in its daily work, you can do the following:
- Avoiding glucose and fructose (juices, sweets) instead: Vegetables, fruits, whole grains, legumes.
- Avoid saturated fats (butter, cream, sausage, cheese, fatty meats, coconut oil and coconut fat) instead: Fatty, plant-based foods for example olives, nuts, avocado, olive, canola and linseed oil.
This lifestyle not only prevents fatty liver disease, it has a positive effect on your entire life: A healthy diet, enough exercise and sleep is considered a precaution for any physical and mental illness. Early detection of fatty liver is difficult because the symptoms appear very late and only nonspecifically.
Course and prognosis of fatty liver
The course of fatty liver disease depends on the behavior of the affected individuals. It is more than an annoying side effect of obesity or alcohol consumption: without comprehensive lifestyle changes, fatty liver can lead to further diseases. This includes:
- Fatty liver inflammation (steatohepatitis)
- Cirrhosis of the liver (shrunken liver)
- Liver cancer (hepatocellular carcinoma)
- Acute liver failure
Moreover, fatty degeneration not only damages the organ itself. The risk of cardiovascular disease, including heart attack, and also type 2 diabetes increases significantly. In the sequelae of fatty liver, other symptoms may show up, such as.
- Skin changes, itching
- Disorders of the hormonal balance
- Impaired blood clotting, frequent bruising, poor wound healing
- Swelling in the right upper abdomen
- Yellowing of the eye white
- Yellow skin (jaundice)
- Enlargement of the spleen
Due to the high regenerative capacity of the liver, further dramatic disease progression can be prevented. The prerequisite, however, is a change in lifestyle.
The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.
Fatty liver: treatment
Fatty liver is curable in many cases. The earlier you deal with the disease and draw the right conclusions for your lifestyle, the greater the chance of a healthy liver.