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What is Non-alcoholic Fatty Liver?

What is Non-alcoholic Fatty Liver?

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Advisory by Shane Liaw, Guardian Pharmacist

Fatty liver is an increasingly common cause of liver disease worldwide. This condition refers to an abnormal accumulation of fats in the liver cells. While excessive alcohol intake is known to be one of the common causes of fatty liver, fatty liver can be caused by other factors not related to heavy alcohol consumption, a variant known as non-alcoholic fatty liver disease (NAFLD).

This type of fatty liver is closely linked to obesity, diabetes mellitus and metabolic syndrome. According to some studies, fatty liver has been shown to affect as much as 70 to 80 percent of obese individuals and up to 70 percent of type-2 diabetic patients. Individuals with hyperlipidemia (high fats level in the blood) or high blood pressure are also at risk of developing fatty liver.

Symptoms of NAFLD
Early NAFLD has no specific symptoms. However, some individuals may experience tiredness, bloatedness, a loss of appetite and sometimes pain in the upper right abdomen. If not properly managed, this condition may lead to non-alcoholic steatohepatitis (NASH), where the liver becomes inflamed. Subsequently, persistent inflammation causes the liver tissues to become scarred, a condition known as liver cirrhosis. The presence of scar tissues in the liver impairs its function, which may lead to liver failure. NASH patients usually experience nausea, jaundice symptoms (the skin and eyes appear yellowish in colour) and a swollen abdomen.

Diagnosis of NAFLD
Liver function tests (LFTs) measure the serum levels of certain enzymes made by the liver cells. An elevation of these liver enzymes may suggest the possibility of liver diseases, including NAFLD. However, LFTs are not used in isolation in the diagnosis of NAFLD as the liver can still function normally despite having fats deposition. Therefore, doctors may carry out other blood tests to rule out other possible liver problems which may share similar symptoms. Besides, imaging studies using high-technology scanning methods such as ultrasound, computer tomography (CT) or magnetic resonance imaging (MRI) may be useful to detect any changes in the liver.

Although not conclusive, the presence of fat accumulation in the liver or an enlarged liver may be an indication of NAFLD. To confirm the diagnosis of NAFLD, liver biopsy may be implemented. This procedure involves the removal of a small sample of liver tissue, with a needle pierced directly onto the skin around that the abdominal area. Sometimes, a liver biopsy may be carried out to determine the severity of liver damage, especially when liver cirrhosis is suspected.

Management of NAFLD
While there is no specific treatment for NAFLD, managing the underlying conditions (e.g. high cholesterol, diabetes or high blood pressure) that contribute to fatty liver is important to prevent the progression of the disease. Besides, it is recommended to avoid any food products that contain trans fat while reducing the intake of highly processed carbohydrates lacking in fibre (e.g. white bread, white rice).

Both processed carbohydrates and trans fats have been known to cause obesity, another risk factor of NAFLD. Increasing the consumption of vegetables, whole grains, legumes and fruits that are rich in anti-oxidants (e.g. vitamin C, vitamin E, selenium) may help to protect the liver from damage caused by free radicals.

Additionally, regular exercise of at least 4 to 5 times a week should be done, with each session lasting 30 minutes. While exercise has not been shown to have any direct impact on fatty liver, exercise have been shown to improve insulin sensitivity and control the progression of diabetes, which are both risk factors for NAFLD. Apart from these measures, it is also advisable to reduce alcohol intake and avoid smoking. Drinking alcohol in excess does have an impact on the liver and smoking itself leads to many adverse health conditions such as liver diseases.

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