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Jennifer Brown, MD
Guest
Fatty liver disease is a harbinger of poor health, but many people are unaware they — and their kids — have it.
Used under author’s license: Shutterstock.com
As a family physician who specializes in obesity, I see patients of all ages with weight-related fatty liver disease. Sadly, even kids as young as eight have a fatty liver these days.
Fatty liver disease affects over 30% of US adults today, up from 16% 30 years ago. Prevalence is expected to exceed 40% by 2050. Usually triggered by obesity, fatty liver disease is also one of the leading causes of liver failure and liver cancer in the world.
Fatty liver disease is precisely what it sounds like — too much fat in the liver. Excess liver fat can lead to swelling, inflammation, scarring, and ultimately, liver failure.
Fatty liver disease is often referred to as a silent killer. Most people with a fatty liver don’t have any associated symptoms. So, it’s not surprising that more than 95% of people who have the condition, also called metabolic dysfunction-associated steatotic liver disease (MASLD), aren’t aware they have it. That lack of knowledge can be deadly.
A study, published earlier this year in the Journal of Hepatology by researchers from Karolinska Institutet in Sweden, found that people with fatty liver disease had nearly double the mortality rate of those with normal livers. Unexpectedly, the most common causes of death for these individuals were cardiovascular events and non-liver cancers, not liver-related deaths.
“Many people are not aware that they have fatty liver disease because it rarely causes any symptoms in the earlier stages,” says Axel Wester, MD, one of the lead authors and assistant professor at the Karolinska Institutet Department of Medicine. “Our study shows that people diagnosed with MASLD have an increased risk of dying from many different diseases, not just liver disease.”
Your personal garbage disposal
The liver, the body’s largest organ, is about the size of a football and located just under the rib cage in the upper right side of the abdomen.
The liver functions as our body’s powerhouse, digesting the food we eat and transforming it into glycogen, a fuel source for our cells. It stores any surplus glycogen, as well as vitamins and minerals, for later use.
It’s also our own personal garbage disposal, cleaning out all the toxic chemicals that build up in our blood from the trash food we eat. Toxins from alcohol, drugs (even prescription drugs), and other environmental poisons are also filtered out by the liver and eventually expelled from our body as urine or stool.
The liver takes a beating. Continuous exposure to toxins results in ongoing cellular damage. The liver is constantly healing itself by replacing its damaged cells. It’s the only organ that can completely regenerate itself.
If part of the liver is removed, the remaining cells divide and grow until the missing part is replaced. The skin continuously replaces cells, as well, but has a limited ability to replace missing sections.
It turns out, most healthy livers are only around three years old, regardless of the person’s age.
Researchers from Dresden University of Technology, led by Olaf Bergmann, PhD, analyzed the postpartum livers of participants aged 20 to 84 years. Surprisingly, in their 2022 study, they found all the livers were the same biological age, regardless of chronological age.
“No matter if you are 20 or 84, your liver stays on average just under three years old,” Bergmann said.
Even unhealthy livers have the capacity to self-heal. Livers scarred by fat deposits, infections like Hepatitis C, or alcohol can regrow healthy tissue, at least to an extent, if the liver toxins are removed and a healthy lifestyle is adopted.
Even if you are older or have been abusing your liver, there’s hope for healing. However, once the damage to the liver reaches a certain point, scarring — instead of healing — occurs, which often can’t be reversed and can cause a spiral into liver failure.
The consequences of excess liver fat
Fatty liver disease develops when excess fat is stored in the liver, typically as a result of overeating and metabolic dysfunction. Excess liver fat causes it to become inflamed and swollen, and as a result, the liver may lose its ability to function correctly.
People who have fatty liver disease usually don’t have any symptoms in the early stages. The disease is generally found accidentally when imaging tests, such as an abdominal CT scan, are ordered for other reasons.
Occasionally, routine blood work might show concerning spikes in liver enzymes in individuals with fatty liver disease. This spike usually prompts a healthcare provider to request further testing, including an abdominal ultrasound to check for fatty liver disease.
Around 30% of people with untreated fatty liver develop a more severe form of liver disease called metabolic dysfunction-associated steatohepatitis (MASH), which can lead to liver scarring (cirrhosis), liver cancer, or death. Those with MASH can develop symptoms such as yellowing of the skin (jaundice), itching, a buildup of fluid in the abdomen (ascites), shortness of breath, and swelling.
Nearly 8% of people with fatty liver disease will go on to develop liver failure or liver cancer and die within 10 years of diagnosis.
Kids are affected by fatty liver disease as well. Ten percent of all kids under 18, and 25% of those who are overweight, have fatty liver disease.
Increased mortality in adults and kids
The Swedish researchers identified more than 13,000 patients diagnosed with MASLD in Sweden between 2002 and 2020 and matched them with healthy participants from the general population, controlling for age, sex, and geographical location. The analysis of the mortality data found that those with MASLD were almost twice as likely to die from any cause, 54% more likely to die from cardiovascular disease, and 47% more likely to die from non-liver cancers.
The researchers also found that people with MASLD also had an increased risk of dying from infections, gastrointestinal diseases, respiratory diseases, and endocrine diseases.
“It is important that we do not only focus on the liver when treating patients with fatty liver disease,” said co-author Hannes Hagström, MD, adjunct professor at the Karolinska Institutet. “A holistic approach and early intervention involving different medical specialties can be crucial to improve the prognosis for these patients.”
A separate study, published earlier this year in the journal Hepatology, found that kids with fatty liver disease (MASLD) are at significantly increased risk of early mortality and long-term liver complications.
The research team followed 1,096 children with fatty liver disease across 8.5 years, during which time 3.5% of the participants died, a mortality rate 40 times higher than that of healthy peers. Nearly half of the deaths were liver-related.
“Every child or young adult who died was a tragedy,” said Jeffrey Schwimmer, MD, lead author and professor of pediatrics at the University of California, San Diego School of Medicine. “MASLD poses a real and measurable threat to pediatric health. To truly change outcomes, we need better tools to diagnose this disease, treatments that work for children, and systems that ensure every child has access to that care.”
Tips for maintaining a healthy liver
You might guess at some of the common advice to keep your liver functioning well. But some of the latest science may surprise you.
Manage weight
Contrary to popular belief, obesity — not alcohol — is the leading cause of liver disease, including liver cancer and liver failure. The best way to prevent both obesity and fatty liver disease is to manage weight effectively. Eat a diet high in nutritious whole foods and low in ultraprocessed junk foods. Choose to drink water, tea, or coffee instead of sugary, high-calorie beverages like soda or sports drinks.
Studies have shown that pairing calorie restriction with a Mediterranean diet is the most effective way to treat and prevent fatty liver disease, as well as many other metabolic diseases. (For more information on the health benefits of a Mediterranean diet, consider reading this Medium story.)
Stay active
Staying physically active also helps maintain a healthy weight and reduces the risk of fatty liver disease. Aim for 150 minutes of aerobic exercise every week (no matter how many days you divide it among), paired with two days per week of whole-body strength training. Building and maintaining muscle mass increases metabolism and decreases fat.
Avoid alcohol
Until the past few years, alcohol was the primary cause of liver disease. As Americans drink less alcohol but eat more ultraprocessed food, obesity is now the primary driver of liver disease. Alcohol, however, continues to add insult to injury.
The current consensus among experts is that no amount of alcohol is healthy. For ideal health, it’s best to avoid it altogether. Drinking even a moderate amount of alcohol can damage your liver, both by alcohol’s toxic effect on liver cells and by increasing fatty liver disease.
Stay socially connected
Social connection is crucial not only to mental health but also to liver health. Negative psychological factors, such as depression, loneliness, and social isolation, are linked to an increased risk of fatty liver disease.
Earlier this year, a team of Chinese researchers analyzed data from over 400,000 participants to determine if there was a link between loneliness and social isolation with the development of MASLD. The study, published in the journal Health Science Data, found that loneliness increased the risk of fatty liver disease by 22%, while social isolation increased the risk by 13%. These risks were independent of obesity, diabetes, and other lifestyle factors.
“Our findings provide robust evidence that loneliness and social isolation are not just mental health issues but also critical factors in the development of metabolic diseases like NAFLD,” said lead author Jiaqi Huang, PhD. “Interventions that target these social determinants, alongside promoting healthier lifestyles, could be transformative for public health.”
Treating fatty liver disease
The cornerstone treatment for fatty liver disease is maintaining a healthy weight through a balanced diet and regular physical activity.
If you already have fatty liver disease that has progressed to MASH and have not been successful at managing it with lifestyle changes, two medications are now FDA-approved for treatment.
Resmetirom, approved last year, works by activating a thyroid hormone receptor in the liver, which decreases fat deposits in the liver. Patients who take resmetirom may experience improvements in liver inflammation and scarring, as well as the resolution of excess fat buildup in the liver.
Semaglutide (Wegovy), approved for the treatment of MASH last month, works by causing weight loss and decreased fat deposits in the liver. Semaglutide suppresses appetite, reduces food cravings, and slows stomach emptying to aid in weight loss. Patients taking semaglutide may have improvement in swelling, inflammation, and scarring in the liver.
If you are overweight or obese and are concerned about the possibility of fatty liver disease, talk with your doctor about testing options, as well as evidence-based ways to manage your weight.
Disclaimer: The content of my stories reflects my professional insights and personal views, but it’s for informational purposes only. This information does not constitute medical advice, diagnosis, or treatment. Always consult your personal physician for any questions you may have about your health.
The Silent Yet Deadly Disease You May Not Know You Have was originally published in Wise & Well on Medium, where people are continuing the conversation by highlighting and responding to this story.
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