Somewhere between 1/4 to 1/3 of the US population will be told at their next visit with their primary care provider that they have a fatty liver. The more official name is hepatic steatosis (metabolic dysfunction-associated steatotic liver disease), but fatty liver is certainly descriptive in normal English. Basically it is just that: excess fat in the liver. So why is this a big deal? The main complication is that it can progress to cirrhosis, which is basically liver cell irritation, then inflammation and death, ultimately leading to liver failure. Most people immediately think: Wait, this is what happens to livers that have been exposed to alcohol – I have an uncle who had that! I’m not an alcoholic! This kind of fatty liver has nothing to do with alcohol but probably is caused by metabolic syndrome, the same entity that leads to type II diabetes, hyperlipidemia (high cholesterol), abdominal obesity, and coronary artery disease.

In fact, the following are major risk factors: BMI >25 (overweight/obesity), hypertension, elevated cholesterol and diabetes. Insulin resistance is thought to be the key mechanism leading to fatty liver. Insulin resistance is decreased responsiveness of the cells to the hormone insulin which is produced in the pancreas and brings glucose, the fuel, to cells to enter. Think of glucose as gasoline, and then you can understand it better. You want just enough: too much is dangerous – think fire! So cells reject too much and then it accumulates in the blood stream. Diabetes is the main disease related to this phenomena.

Almost everyone with beginning fatty liver has no obvious symptoms. In fact it most often is found incidentally with imaging done for a different reason. Typically an ultrasound which includes the liver will show it. Then secondly, lab work is associated with the finding: most often elevated liver enzymes including aminotransferases (ALT and AST).

Your primary care provider will want to rule out the scary causes of liver inflammation including hepatitis from viruses (like hepatitis A, B, C), iron problems, biliary disease (gallbladder), liver autoimmune disease, and some other rare diseases. Then it is helpful to evaluate liver stiffness, which is correlated with the severity of liver fibrosis, which is the state that leads to cirrhosis. This can be done with a ultrasound-based study (like VCTE), which will then give a score which is a measure of how bad the condition has evolved.

The more liver damage, the more problematic alcohol is for the person with fatty liver. Personally, I would avoid if you have any signs of hepatic steatosis.

What is the solution to this? Guess what! It is the same as the solution to most diseases in our part of the world:

• Avoid alcohol
• Eat a healthy diet consisting of lots of vegetables, fruits, whole grains (garden food)
• Exercise and stay active as a lifestyle

The liver is another organ to ponder and avoid damaging. Healthy lifestyle is key to liver health.