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Rise in Fatty Liver Disease

Obesity, Sedentary Lifestyles, and Alcohol to Blame

New York (Oct 20, 2010)

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It's well known that obesity is increasing at an alarming rate in the United States, fueled by over-sized food portions, over-scheduled families who rely on fast-food chains for dinner, and a scarcity of daily physical activity. Diabetes incidence is on the rise as well. These trends are also contributing to an escalation in the diagnosis of another worrisome illness: fatty liver disease.

Fatty liver disease affects as many as one in five adults and, with the rise in pediatric obesity, one in 20 children in America. Most of the time, it causes no significant trouble. But it can progress to inflammation, and in some patients, cirrhosis. About half of all patients with cirrhosis had fatty liver disease.

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When the cirrhosis becomes so advanced that it severely compromises liver function, the patient may even need a liver transplant. "The number of patients who need a liver transplant as a result of fatty liver disease could possibly surpass the number of people who need a transplant because of hepatitis C," noted Scott Fink, M.D.

Scott A. Fink, M.D.
Scott A. Fink, M.D.

There are ways to reverse early fatty liver disease and to reduce the risk, but there is no proven cure. A low-fat diet and exercise are the best defenses. NewYork-Presbyterian offers outpatient evaluation and comprehensive care for patients with fatty liver disease, and also offers liver transplantation for those in need.

Alcohol abuse can also cause fatty liver disease. Individuals with the illness who don't have a history of alcohol abuse often have a condition called "metabolic syndrome," in which the body has trouble processing fats and sugars. These individuals are commonly obese, have high blood levels of triglycerides, and have type 2 diabetes. In some cases, however, the illness develops in someone without any known risk factors.

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When non-alcoholic fatty liver disease progresses to inflammation, it is called "non-alcoholic steatohepatitis," or "NASH," which is rising in incidence in this country.

Fatty liver disease often causes no symptoms. However, it may reveal itself if routine blood tests show elevations in certain liver enzymes, or, if symptoms are present, when a patient complains of fatigue and abdominal pain and has a liver that feels enlarged upon examination. In these situations, the doctor may order an ultrasound or a computed tomography (CT) scan to assess the liver, but only a liver biopsy (examination of a small amount of liver tissue) can confirm a diagnosis of fatty liver disease.

Sonja K. Olsen, M.D.
Sonja K. Olsen, M.D.

Surrogate markers such as spleen size, platelet count, albumin levels, and blood clotting time may also be assessed. Because there is no way to diagnose fatty liver disease other than by biopsy, researchers are trying to develop non-invasive blood tests to detect the disease.

Once a patient is diagnosed with fatty liver disease, lifestyle changes are in order to try to reverse it and keep it from progressing to cirrhosis. "The only proven therapy and the gold standard is weight loss," explained Sonja Olsen, M.D.

Patients are advised to adopt a low-fat diet and increase the amount of physical activity in their lives. And as with all liver diseases, they must abstain from consuming alcohol. Clinical trials have been conducted to assess the value of diabetes drugs (such as metformin and pioglitazone), but the results have not been conclusive. "We're awaiting the results of large-scale studies to assess the benefits of these drugs," said Dr. Fink.

The care of patients with fatty liver disease requires a multidisciplinary team of endocrinologists, hepatologists, primary care physicians, and nutritionists. This is the approach taken by the specialists at NewYork-Presbyterian. Concluded Dr. Olsen, "All of these individuals collaborate to present a consistent message to the patient."

Contributing faculty for this article:

Sonja K. Olsen, M.D. is an Assistant Attending Physician at NewYork-Presbyterian/Weill Cornell Medical Center and an Assistant Professor of Medicine at Weill Cornell Medical College.

Scott A. Fink, M.D. is an Assistant Attending Physician at NewYork-Presbyterian/Columbia University Medical Center and an Assistant Professor of Medicine (in Surgery) at Columbia University College of Physicians and Surgeons.

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