“Some of my friends have developed fatty liver disease and they are so young. Why is this happening to them? ”
—Luc G., Cambrian College, Ontario
When “fatty liver” is translated literally into French it becomes foie gras. Do you know how foie gras is made? Farmers force-feed ducks or geese until eventually their liver becomes very full of fat. While we do not know the exact mechanism that leads to the development of this abnormality in humans, we do know it has some relationship with poor nutritional habits.
What is non-alcoholic fatty liver disease?
When people talk about fatty liver, they are usually referring to non-alcoholic fatty liver disease (NAFLD). With NAFLD, the liver cells get infiltrated with fat. (We all know that drinking alcohol regularly can lead to liver disease. In its milder form, this may simply appear like a fatty liver, but as it becomes more serious it may present as cirrhosis. Cirrhosis is the destruction of liver cells caused by alcohol.)
Between 1988 and 2008, NAFLD doubled in prevalence and became the most common cause of chronic liver disease, according to a 2011 study by the Center for Liver Disease in Virginia. During the same time we have also observed an increase in obesity, high cholesterol levels, high blood pressure, and diabetes. This is called the “metabolic syndrome”. This does not mean that the metabolic syndrome causes NAFLD, but there is a relationship between the two and it can occur at any age.
How do you know you have it and what does it mean?
Most people have no symptoms. Fatty liver can be diagnosed when a blood test for the liver is done and found to be abnormal. However, this does not mean that abnormal liver test results are all related to fatty liver, so further tests are required. The most useful test is an ultrasound or MRI.
Most people have no long-term consequences except for those that have the inflammatory type, which may lead to cirrhosis. However, getting to that diagnosis is not simple, and even if the diagnosis of an inflammatory condition is made, we do not know who will progress to severe disease.
What can you do if you have it?
We don’t really know. However, as previously mentioned, fatty liver is often linked to other conditions that are concerning for long-term health. And, interestingly enough, by managing these conditions—e.g., losing weight or controlling blood sugar or cholesterol—you can also improve fatty liver disease.
The lesson to be learnt: Don’t be a goose. Eat well and don’t force-feed yourself, and you may avoid this problem. However, stay tuned: it may not be this simple. There’s a lot still to be learned about this condition.
Dr. Pierre-Paul Tellier is associate professor of family medicine and director of student health services at McGill University in Quebec.