DEAR DOCTORS: My father passed away due to unexplained liver problems that we only now know was fatty liver disease. It's 20 years later, and a CT scan shows some fat in my own liver. My liver readings are normal, but I'm the same age as my father was when his issues began. Should I be concerned?
DEAR READER: The term fatty liver disease refers to a range of liver disorders that are not caused by alcohol consumption, autoimmune disease, drug use or virus. It's the most common liver disease in the US, and it is estimated to affect up to 30% of individuals. Once known as nonalcoholic fatty liver disease, the condition is now more accurately called metabolic-associated fatty liver disease, or MAFLD.
Your father's health problems arose when this type of fatty liver disease was in the early stages of being understood. Although alcohol-induced changes to the liver were first described in the 1840s, it wasn't until the 1980s that a metabolic cause for fatty liver disease began to emerge. A series of studies conducted throughout the decade revealed that metabolic abnormalities unrelated to alcohol use can also cause fatty liver disease. All these years later, with a clearer understanding of MAFLD, you are in a better position to understand and monitor the health of your own liver.
Fatty liver disease is just as it sounds -- an abnormal buildup of fat in the liver. While a healthy liver contains some fat, when the amount begins to exceed 5% to 10%, it is considered to be fatty liver disease. This excess fat triggers an inflammatory response that, over time, leads to liver damage. That means the liver's hundreds of metabolic functions, which include filtering toxins, aiding in digestion, blood-sugar management, and creating and storing nutrients, are adversely affected. The condition is linked to being overweight or obese, high blood-lipid levels, high blood pressure and prediabetes and diabetes.
There is some evidence of a higher risk of developing MAFLD when the condition runs in a family. However, the lifestyle and environmental factors that we previously mentioned appear to play a more significant role.
The condition has few symptoms. Some people describe feeling tired, and some experience discomfort or pain in the upper right portion of the abdomen. This makes the disease challenging to diagnose. Abnormal results of liver-enzyme tests can be an indicator. So can a stiff or enlarged liver, as well as jaundice, which is a condition that causes the skin and the whites of the eyes to turn yellow.
When fatty liver disease is suspected, imaging tests may be used to assess the amount of fat in the liver. A biopsy to check for abnormal amounts of scar tissue in the liver, known as fibrosis, may also be requested.
It's important that, going forward, you let your health care providers know you have a family history of fatty liver disease. Meanwhile, you can take steps to reduce your risk. These include staying away from alcohol, maintaining a healthy weight, choosing a healthful diet rich in fresh, plant-based foods, and getting regular exercise. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.
