What Is Fatty Liver Accumulation?

Fatty liver accumulation refers to a condition where there is an accumulation of fat, specifically triglycerides, in liver cells. It occurs in individuals who do not consume alcohol or consume it in minimal quantities (typically, individuals who have been heavy drinkers may have fatty deposits in the liver). In the medical field, this condition is known as Non-Alcoholic Fatty Liver Disease (NAFLD). The presence of fat cells does not initially cause damage or inflammation to the liver.

However, in some cases, the fat can lead to liver inflammation and eventually progress to a hardened liver. It has been found that 5-8% of individuals with fatty liver deposits may develop liver inflammation, and 2% of those with a hardened liver may develop liver cancer.

In Asian populations, approximately 15% of the general population has fatty liver deposits, with a prevalence of 3.9-6% in children and adolescents. The condition is more common in individuals who exhibit clinical characteristics of metabolic disorders, such as obesity, diabetes, high blood pressure, and high blood lipid levels.

Disease progression:

Patients with fatty liver accumulation without liver inflammation have similar survival rates as the general population of the same gender and age. However, in patients with non-alcoholic fatty liver disease (NAFLD) and internal liver inflammation, liver hardening and chronic liver disease can be detected. Blood tests may show elevated levels of AST and ALT enzymes, typically 1.5-4 times higher than normal, and ALP levels may slightly increase, while other values tend to remain within normal ranges. NASH, a more severe form of NAFLD, has a shorter lifespan compared to patients with simple fatty liver accumulation.

In patients with liver inflammation, 32-41% will experience increased liver fibrosis over a period of 4-14 years. Additionally, 9% will progress to liver hardening, and 2% of those with a hardened liver will develop liver cancer within an average of 14 years. Patients with fatty liver accumulation are often directly associated with metabolic disorders, increasing the risk of cardiovascular events and mortality, particularly due to coronary and cerebral vascular diseases.

Diagnosis:

In most cases, there are no symptoms, and the condition is often incidentally discovered during routine health check-ups or blood tests. Some individuals may experience mild pain or discomfort in the right upper abdomen, easy fatigue, or a feeling of fullness in the upper right abdominal region. Physical examination may reveal an enlarged liver, and abdominal ultrasound can detect fatty liver accumulation. However, in patients with fatty liver accumulation, if the fat accumulation in the liver is less than 30% of the liver volume, it may not be visible on ultrasound.

Before diagnosing fatty liver accumulation (NAFLD), it is essential for physicians to obtain a medical history to assess whether the problem is not caused by any specific diseases or medications, and patients should not consume alcohol in quantities greater than 10 grams per day for women and 20 grams per day for men. This is because patients with alcoholic liver disease have liver tissue characteristics similar to those with fatty liver accumulation. Therefore, alcohol consumption history must be checked during the diagnosis.

Liver biopsy remains a standard method for diagnosing NAFLD, particularly NASH. However, in obese and diabetic patients who consume alcohol, it can promote fat accumulation in the liver. Additionally, patients should be screened for viral hepatitis B and C infections before diagnosing NAFLD, as they are common causes of chronic liver disease in Thailand.

Assessment of hepatic steatosis in NAFLD patients:

In patients with fatty liver disease, if there is inflammation or fibrosis in the liver tissue, it can progress to liver stiffness and eventually lead to liver cancer. The standard method used to assess hepatic steatosis is liver biopsy, which involves the invasive procedure of liver puncture. However, due to its relatively aggressive nature and the discomfort it causes to patients, this method is not commonly used nowadays, except when there are necessary indications for the examination. These indications may include suspected inflammation due to autoimmune hepatitis, non-alcoholic steatohepatitis (NASH) of unknown cause, non-cirrhotic portal hypertension, or unexplained liver stiffness. Currently, there are non-invasive methods available for hepatic steatosis evaluation.

One such method is the use of Fibroscan or Transient Elastography, which measures the liver tissue's elasticity and can assess the severity of hepatic steatosis occurring in the liver. The principle involves emitting waves into the liver tissue and calculating the shock wave velocity that is reflected back. This velocity is directly related to the density of hepatic steatosis in that particular area. Additionally, the Controlled Attenuation Parameter (CAP) can be measured, which is correlated with fat accumulation in the liver. The CAP values range between 100 and 400 dB/m and can be used to diagnose different levels of hepatic steatosis severity.

Treatment:

Patients often face weight-related issues or obesity, so weight reduction is crucial and highly beneficial. This can be achieved through controlling the quantity and quality of food intake, specifically by avoiding high-fat foods such as milk, butter, coconut milk, seafood, and egg yolks. Triglycerides, which play a significant role in liver accumulation, should also be avoided, and excessive consumption of starchy and sugary foods should be limited. It is important to note that weight loss should not be pursued through fasting or excessive rapid reduction.

In general, it is recommended to reduce weight by approximately 7-10% from the initial weight. If the patient can achieve a body mass index (BMI) below 25 kg/m², it would be even better. Furthermore, treating other metabolic disorders that may coexist involves controlling blood sugar and lipid levels to approach normal ranges and avoiding alcohol consumption. Regular physical exercise is also crucial, as it not only reduces hepatic steatosis but also lowers the risk of cardiovascular diseases.

With best wishes from

Gastrointestinal Center

Vibhavadi Hospital

Tel 02-561-1111 ext. 4525