What is fatty liver disease?

Fatty liver disease is a condition where more than 5% of the liver's weight is accumulated in the liver due to fat accumulation. This can progress to hepatitis, cirrhosis, and even liver cancer. Causes include alcohol consumption, lifestyle choices, underlying medical conditions, side effects from certain medications, and genetic disorders.
Symptoms of fatty liver disease include fatigue, mild nausea, pain or tenderness in the right upper abdomen, abdominal pain, unexplained weight loss, jaundice (yellowing of the skin and whites of the eyes), edema in the abdomen or legs, extreme tiredness, and confusion.
Complications of fatty liver disease that should not be overlooked include chronic hepatitis, liver fibrosis, cirrhosis, and liver cancer.
Prevention of fatty liver disease involves safe weight loss, regular exercise, a healthy diet, managing underlying medical conditions, being cautious with medications and supplements, abstaining from all alcohol, and regular health checkups.

Fatty liver disease is a silent threat that many people mistakenly believe only affects overweight individuals. In reality, anyone can develop it. Fatty liver is a condition where more than 5% of the liver's weight is accumulated as fat in the liver. Excessive fat accumulation can increase the risk of cirrhosis and liver cancer. This article will introduce you to fatty liver disease, its symptoms, and important causes to watch for, for optimal liver health.

What is fatty liver disease?

Fatty liver disease is a condition where fat accumulates in the liver exceeding 5% of its weight. Normally, the body uses fat from the abdomen and liver as energy, especially liver fat, which is the primary energy source. However, excessive accumulation can negatively impact health, potentially leading to hepatitis, cirrhosis, and even liver cancer in the long term.

How many stages are there in fatty liver disease?

Stage 1 Fat begins to accumulate in the liver tissue, but at this stage, there are no symptoms of inflammation or fibrosis.
Stage 2 The liver begins to become inflamed. If left untreated or without lifestyle changes for more than 6 months, it can develop into chronic hepatitis.
Stage 3 Severe and continuous inflammation begins to damage liver cells, leading to fibrosis replacing healthy liver tissue.
Stage 4 Liver cells are so damaged that the liver can no longer function normally, leading to cirrhosis and a high risk of developing liver cancer.

What are the symptoms of fatty liver disease?

Feeling tired.
Mild nausea.
Pain or tightness in the right upper rib cage area.
Abdominal pain or a feeling of fullness in the right side of the abdomen.
Nausea, loss of appetite, or unusual weight loss.
Jaundice (yellowing of the skin and whites of the eyes).
Swelling in the abdomen or legs.
Feeling extremely tired or confused.

Causes of fatty liver disease:

Alcoholic fatty liver disease is caused by consuming large amounts of alcohol over a long period. Alcohol interferes with the liver's fat metabolism, leading to fat accumulation and eventually cirrhosis or liver cancer.
Non-alcoholic fatty liver disease is mainly caused by health and lifestyle factors such as obesity, diabetes, high blood pressure, high cholesterol, a diet high in fat, carbohydrates, or sugar, lack of regular exercise, side effects from certain medications, hepatitis virus infection, or genetic abnormalities.

Who is at risk for fatty liver disease?

Abdominal obesity.
Certain underlying medical conditions, including obesity, diabetes, and high cholesterol.
Regularly consuming high-energy foods, especially those high in fat, sugar, or carbohydrates. Risk factors for fatty liver disease include:
Menopausal women
People with sleep apnea
Certain medications, such as steroids, chemotherapy, and some antiviral drugs
Heavy alcohol consumption
People with normal weight but high visceral fat or a preference for sweets

Complications related to fatty liver disease:

Non-associated hepatitis B (NASH): Excessive fat accumulation triggers inflammation in the liver tissue, ultimately leading to liver cell damage.
Liver fibrosis: Continuous liver inflammation causes the body to create scar tissue to replace healthy liver tissue, reducing liver function.
Cirrhosis: The final stage of liver disease where the liver completely loses its function. Most of the liver tissue is replaced by hardened, fibrous tissue.
Liver cancer: Patients with cirrhosis caused by fatty liver disease have a very high risk of developing liver cancer.

Diagnosis of Fatty Liver Disease

Blood tests: In the early stages, liver enzyme levels may appear normal. However, if inflammation begins, indicators such as ALT, AST, and ALP will be elevated. Screening for hepatitis B and C viruses, as well as co-existing conditions such as diabetes and high cholesterol, should also be performed.
Ultrasound: Used to examine the liver's structure and detect fat accumulation. Fat accumulation is detected when it exceeds 30%. However, this method may have limitations in individuals with thick abdominal walls or those who are overweight.
Liver biopsy: A method that provides a clear diagnosis or can be used to differentiate from other conditions with similar symptoms. However, it is not currently the preferred first-line diagnostic option.
FibroScan: This technology uses sound waves to assess the degree of fibrosis and elasticity, as well as accurately measure the amount of fat accumulation in the liver. It is a quick, painless procedure that helps doctors plan effective treatment.

How to Screen for Fatty Liver Disease

Early screening for fatty liver disease can be done in several ways. It begins with blood tests to check liver enzyme levels (AST, ALT) for abnormalities, along with an upper abdominal ultrasound to examine the characteristics of fat accumulation in the liver tissue. Additionally, FibroScan is used to accurately measure fat content and assess fibrosis levels. These tests are important for those at risk, such as those with obesity, diabetes, or high cholesterol levels.

Treatment Methods for Fatty Liver Disease

Treatment in Stages 1-2:

Abstain from alcohol to reduce liver damage.
Dietary control: Choose low-fat foods, emphasizing fruits and vegetables.
Exercise and weight management: Exercise regularly to maintain a healthy weight.
Medication: In some cases, doctors may prescribe additional medications to reduce liver fat or help control blood sugar levels.

Treatment in Stages 3-4:

Lifestyle modifications: Combined with medical treatment.
Medication to control the disease: In cases with hepatitis, doctors may consider prescribing anti-inflammatory drugs, weight-loss medications, or drugs to control liver fat.
Prevention of complications: Focuses on preventing the disease from progressing to more dangerous stages.
Close monitoring: Doctors will schedule regular blood tests and ultrasounds to closely monitor for cirrhosis and liver cancer.

How to Prevent Fatty Liver Disease

Safe weight loss: If overweight, lose weight gradually at a rate of 0.25–0.5 kg per week until you reach a healthy weight.
Regular exercise: Exercise at least 5 days a week, incorporating cardio (such as brisk walking for 30 minutes) and resistance training (such as low-impact weightlifting).
Healthy diet: Focus on low-energy, low-fat, and high-fiber foods. Avoid fried foods and high-fat foods such as milk, butter, coconut milk, and cheese. Limit your intake of carbohydrates and sugar at each meal.
Control underlying conditions: If you have diabetes or high cholesterol, strictly follow your doctor's instructions regarding medication, along with dietary control and exercise.
Be cautious with medications and supplements: Avoid taking medications or supplements not recommended by your doctor.
Abstain from all types of alcohol.
Regular health checkups: Undergo regular health checkups to monitor liver function and watch for fatty liver disease.

Which medications should be avoided for fatty liver disease?

In addition to self-care for fatty liver disease, let's look at some medications that should be avoided.

Medications that directly affect the liver include: paracetamol (a pain reliever if taken in overdose), antiviral drugs, and chemotherapy drugs for cancer treatment.
Steroids (both oral and topical) when used continuously for a long time.
Statins (lipid-lowering drugs), although used to treat/dissolve blood fats, must be used with caution in patients with severe fatty liver disease or hepatitis.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen and Naproxen (pain relievers).
Some antibiotics and antifungal drugs, such as the antifungal drug Fluconazole, as well as drugs used to treat tuberculosis, such as Isoniazid, Rifampin, and Pyrazinamide.
Herbal remedies and supplements, such as Andrographis paniculata, Tinospora cordifolia, Cassia siamea, and Puffball mushrooms, can also affect the liver if taken in overdose or for extended periods.
Oral contraceptives.

How much does it cost to check for/treat fatty liver disease?

Liver fat screening in Thailand begins with a blood test to check liver function, costing approximately 500–2,000 baht. For higher accuracy, a FibroScan test costs around 1,800–3,500 baht per session, often included in a package deal with a doctor's fee. Treatment focuses on lifestyle modifications combined with medication, which may incur additional costs ranging from hundreds to thousands of baht per month depending on the severity of the disease. Therefore, budget approximately 2,000–4,000 baht for the initial screening, with potential costs for follow-up and long-term medication.

Liver Fat Screening at Vibhavadi Hospital

Fatty liver is a silent threat that can affect anyone. Neglecting it can lead to more serious conditions. If you are interested in a health checkup and liver fat screening, you can visit the Gastroenterology Center at Vibhavadi Hospital. They offer consultations on reducing liver fat, targeted treatment with modern technology, leading to improved symptoms and better liver health.

Summary

Fatty liver is a condition where more than 5% of the liver tissue is accumulated with fat, increasing the risk of hepatitis, cirrhosis, and liver cancer. It is classified into four stages and often shows no symptoms in the early stages. However, there may be warning signs such as fatigue or tightness in the right rib cage. The main causes are eating habits, alcohol consumption, and metabolic disorders. Diagnosis can be made through blood tests, ultrasound, or fibroScan.

Treatment focuses on weight management, exercise, abstaining from alcohol, avoiding liver-damaging medications, and close monitoring to prevent life-threatening complications. You can undergo testing and diagnosis by expert physicians at Vibhavadi Hospital for targeted treatment.

FAQ – Frequently Asked Questions

How long can fatty liver disease last?

Fatty liver disease is often discovered incidentally during routine health checkups. It usually manifests as abnormally high liver function test results or the beginnings of liver inflammation. If left untreated, it can have serious long-term consequences, potentially leading to cirrhosis. Generally, fatty liver disease takes about 10-15 years to develop into cirrhosis.

What foods should be avoided when you have fatty liver disease?

Avoid alcohol, sugary drinks, and carbonated beverages, as well as high-fat foods such as fried foods, coconut milk products, butter, and cheese. Limit your consumption of refined carbohydrates and baked goods like white rice and white bread, as well as processed meats such as cured sausages and regular sausages. Also, avoid foods at risk of mold contamination, such as ground peanuts and salted fish, to reduce the burden on the liver.

What fruits should people with fatty liver disease eat?

For fatty liver disease, focus on consuming fruits and vegetables high in fiber and low in sugar to aid digestion and control blood sugar levels. Recommended vegetables include broccoli, kale, cabbage, spinach, radish, carrots, cauliflower, tomatoes, cucumbers, and water spinach. Suitable fruits include avocado, apple, guava, watermelon, and oranges.

Is fatty liver cancerous?

If fatty liver is left untreated, there is a high risk of it developing into liver cancer. The accumulated fat is the starting point that triggers chronic liver inflammation, leading to fibrosis and cirrhosis. This is a significant risk factor that can cause liver cells to transform into cancerous cells in the long term.

Is itching a symptom of fatty liver?

Itching can indeed be a sign of liver abnormalities, but it doesn't only occur in those with fatty liver. It's more often seen in patients with chronic hepatitis or cirrhosis, resulting in bile stagnation. The prominent symptom is itching on the palms, soles, or spreading throughout the body, without a visible rash on the skin.

What are some liver-nourishing drinks?

Choosing the right drinks greatly contributes to liver recovery and nourishment. In particular, black coffee without sugar, green tea, lemon or lime juice, turmeric water, mint tea, and beetroot juice can help improve liver function.

What vitamins support liver health?

Choosing the right vitamins and nutrients greatly contributes to liver health, especially vitamin E, B vitamins (particularly B6, 9, and 12), lecithin, choline, and glutathione, which help strengthen liver function.

Can people with fatty liver disease eat durian?

Durian consumption should be strictly avoided or limited because it is a fruit high in fructose, fat, and calories, which directly contributes to increased fat accumulation in the liver. This can help prevent liver inflammation or worsening symptoms of fatty liver disease.

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