Fatty Liver Disease

Fatty Liver Disease

Fat in the liver typically develops when a person consumes more fat and sugars than his or her body can handle. This is more common in people who are overweight or obese, but can also occur in adults with healthy body weights. If that fat builds up to more than 5% of the liver, then the liver is considered to be a fatty liver. Although having this condition may not cause any immediate harm, there is a concern that the extra fat in the liver might make the liver vulnerable to further injury such as inflammation and scarring.

An illustration showing the difference between a normal liver and a liver that has nonalcoholic fatty liver disease
Used with permission from Mayo Clinic. All rights reserved

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What is Non-Alcoholic Fatty Liver Disease (NAFLD)?

Non-alcoholic fatty liver disease (NAFLD) is a liver disease affecting people who drink little to no alcohol. As the name implies, the main characteristics of NAFLD is too much fat stored in liver cells. NAFLD is the most common liver disease in Canada affecting about 20% of Canadians.

It tends to develop in people who are overweight or obese, particularly if they have lot of fat around the middle of their body (waist). It can also develop in a person whose body weight is in the healthy weight range, but who typically eats a lot of sugary and fatty foods and who has extra fat around the waist. NAFLD has shown to be strongly associated with metabolic syndrome- a health disorder characterized by a group of risk factors (large waist circumference, high blood pressure, high blood sugar levels, high cholesterol, and abnormal amounts of lipids in the blood) that greatly increase the risk of many chronic illnesses.

Causes

The most common cause of fatty liver disease in Canada is obesity. In 2018, almost 30% of Canadians 18 and older (roughly 7.3 million adults) reported height and weight that classified them as either overweight or obese.

Besides obesity, nutritional causes of fatty liver disease are:

  • Starvation and protein malnutrition
  • Long-term use of total parenteral nutrition (a feeding procedure that involves infusing nutrients directly into the bloodstream)
  • Intestinal bypass surgery for obesity
  • Rapid weight loss

Certain conditions often accompany and may contribute to fatty liver disease:

  • Diabetes mellitus
  • Hyperlipidemia (elevated lipids in the blood)
  • Insulin resistance and high blood pressure

Other causes include:

  • Genetic factors
  • Drugs and chemicals

How do we define “Overweight” and “Obese”?

A body mass index chart showing the risk for fatty liverAlthough many people feel they could lose some weight, few would consider themselves obese. A widely-used measure to define “overweight” and “obese” is the Body Mass Index (BMI). A BMI is a calculation based on your height and weight that gives a number that reflects either a healthy or unhealthy weight.

You can use the following formula to calculate your BMI: 

BMI:
Weight in kg
________________
(Height in meters)2

Example: for someone who is 1.70 meters tall who weighs 80 kilograms: 

BMI  = 80 ÷  (1.70 x 1.70) = 27.7. Click here to access the BMI Calculator

UnderweightNormalOverweightObese
Less than 18.519.6-24.925-29.930 or greater

Note: Different ethnic groups may differ slightly – for example, in Asian populations the healthy BMI is lower, ranging from 18 – 23.

A green apple is wrapped up in a measuring tape commonly used to measure one's bodyDoes the size of your waist matter?

Excess abdominal fat is associated with fatty liver disease and other health risks such as diabetes. Waist measurements – which differ according to gender – are used to identify the health risks associated with excess abdominal fat:

  • For men, health risks increase if your waist circumference is more than 102 cm (40 in.)
  • For women, health risks increase if your waist circumference is more than 88 cm (35 in.)

It is important to measure your waist circumference in a consistent way. The best way to do this is:

  • Wrap a measuring tape 2 cm higher than your belly button.
  • The tape should be snug but not pressing into your bare skin.
  • Relax, exhale and read the measurement.

How does fat get into the liver?

Fat and sugars from a person’s diet are usually broken down by the liver and other tissues. If the amount of fat or simple sugar intake exceeds what is required by the body, fat is stored in the fatty tissue. Other reasons for accumulation of fat in the liver could be the transfer of fat from other parts of the body or the inability of the liver to change it into a form that can be eliminated.

What is NASH?

NASH stands for non-alcoholic steatohepatitis and is the more serious form of NAFLD. In this condition, the liver becomes inflamed and has scarring (fibrosis).

NASH can lead to severe scarring in the liver and up to 11% may experience liver related deaths. Some people who have NASH may need a liver transplant due to chronic liver failure.

Can children develop fatty liver disease?

Fatty liver disease is now becoming evident in children, due in large part to an alarming increase in childhood obesity. It is estimated that one in 10 Canadian children is overweight – a number that has almost tripled in the last decade. Fatty liver disease affects almost 3% of children and 25 – 55% of obese children. Fatty liver disease can be found in children as young as two years of age.

Symptoms

In general, people with fatty liver disease have no symptoms. However, some people report discomfort in the abdomen at the level of the liver, fatigue, a general feeling of being unwell and vague discomfort.

Diagnosis

Fatty liver disease is usually suspected in people who are overweight and obese (particularly those with large waist circumferences), who have evidence of dyslipidemia (high cholesterol and lipids in the blood), insulin resistance and/or abnormal liver tests.

An ultrasound or Fibroscan® of the liver can show the presence of a fatty liver. In some cases, your doctor may advise a liver biopsy, a procedure where the physician inserts a needle into the liver and extracts  sample tissue, which is then examined under a microscope.

Treatment

Once there is a buildup of simple fat, the liver becomes vulnerable to further injury, which may result in liver inflammation and scarring (NASH). The treatment of fatty liver disease is related to the cause. At this time, it is not possible to predict which patients will develop NASH.

  • Individuals who are obese are advised to achieve a gradual and sustained weight loss through proper nutrition and exercise.
  • Those with diabetes and high lipids in their blood have to improve their sugar control and lower lipids levels. Usually, a lower fat, lower calorie diet with avoidance of sugary foods is recommended along with insulin or medications to lower blood sugar in people with diabetes. If you have diabetes, please see your healthcare provider who can advise you how to manage your diabetes.
  • For individuals with NASH who are not overweight and not diabetic, a diet with lower fat foods without a lot of added sugars is often recommended.
  • It is also recommended that people avoid drinking alcohol and sugary sweetened foods since they can cause and contribute to fatty liver disease.
  • Increasing physical activity is also recommended.
  • People with fatty liver disease should see their primary healthcare providers on a regular basis and seek out the advice of a dietitian regarding their diet.
  • Several studies have shown that drinking coffee (2-3 cups per day) may slow the progression of liver damage and reduce the risk of liver cancer in people who have fatty liver disease.

Currently, there is no medication proven to effectively treat fatty liver disease. The treatment is typically based on lifestyle modification, gradual and sustained weight loss through proper nutrition and exercise. Since it is now such a common condition, it has raised a lot of interest in the scientific community. There are now a number of clinical trials looking at various treatments of fatty liver disease.

Prevention

By adopting a healthy lifestyle, you may prevent obesity – the number one reason for fatty liver disease. Please remember that a healthy diet and exercise are important components of any weight-loss regimen. The following are some suggestions for preventing fatty liver disease:

  • If you are overweight, strive for a gradual and sustained weight loss.
  • Eat a well-balanced diet that is low in saturated fats and simple sugars and high in fibre.
  • Introduce exercise into your routine, at least four times a week. You can enjoy walking, swimming, gardening, stretching.
  • Avoid alcohol.

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Support

National Help Line:
This support resource gives you and your loved one somewhere to turn for answers after diagnosis, helps you understand your disease, and provides you with the resources you need.  You can call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST.

The Peer Support Network:
This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like you who have a family member who has liver disease, who care for someone who suffers from liver disease, or who have been diagnosed with a liver disease, to talk about your concerns with a peer in a similar situation.

If you would like to be connected with a peer supporter in your area, or would like to join the peer support network, please call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST or email us.

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Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;25(8):883-9. doi:10.1111/j.1365-2036.2007.03246.x.
Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE. Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2008;28(1):13-24. doi:10.1111/j.1365-2036.2008.03703.x.
Connor Gorber, S., M. Shields, M.S. Tremblay, and I. McDowell. 2008. The feasibility of establishing correction factors to adjust self-reported estimates of obesity. Health Reports. Statistics Canada Catalogue number 82-003, Vol. 19, no. 3. (accessed January 17th, 2017).
Health Canada. Obesity. 2006. (accessed April 3rd, 2019)
Lebovics E, Rubin J. Non-alcoholic fatty liver disease (NAFLD): why you should care, when you should worry, what you should do. Diabetes Metab Res Rev. 2011;27(5):419-24. doi:10.1002/dmrr.1198.
Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10(11):686-90. doi:10.1038/nrgastro.2013.171.
Metabolic Syndrome. National Heart, Lunge, and Blood Institute (2019). US Department of Health & Human Services. Retrieved from https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome
Ovchinsky N, Lavine JE. A critical appraisal of advances in pediatric nonalcoholic Fatty liver disease. Semin Liver Dis. 2012;32(4):317-24. doi:10.1055/s-0032-1329905.
Public Health Agency of Canada, Canadian Institute for Health Information. Obesity in Canada.; 2011:62.
WHO. Waist Circumference and Waist-Hip Ratio: report of WHO Expert Consultation. Geneva; 2011:39.