Steatotic liver disease (Fatty Liver)

OVERVIEW FATTY LIVER

Previously, steatotic liver disease was known as “fatty liver disease.” In 2023, experts renamed the condition and its subcategories to reflect its causes more accurately. Steatotic (Fatty ) liver disease (SLD) involves having excess fat in your liver. Depending on the type of SLD you have, the fat buildup may not cause problems, or it may lead to liver damage. Steatotic (Fatty )  liver disease (SLD) includes several conditions associated with steatosis in your liver. “Steatosis” is a term healthcare providers use to describe fat buildup in an organ (usually your liver). A healthy, high-functioning liver contains a small amount of fat. Fat buildup becomes a problem when it reaches over 5% of your liver’s weight.

TYPES IF FATTY LIVER

There are two main types of fatty liver disease

1. Nonalcoholic fatty liver disease (NAFLD): A buildup of fat in the liver that's not caused by heavy alcohol use. NAFLD is the most common chronic liver disorder in the United States. NAFLD can be further divided into two subgroups:

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  • Non-alcoholic fatty liver (NAFL): The mildest form of NAFLD, with no evidence of hepatocellular injury. 
  • Non-alcoholic steatohepatitis (NASH): A more advanced form of NAFLD, with fat, inflammation, and liver damage.

1. Alcoholic fatty liver disease: A buildup of fat in the liver caused by heavy alcohol use. 

CAUSES OF FATTY LIVER

• Alcohol use disorder (frequent or heavy alcohol use).
• Metabolic syndrome (insulin resistance, high blood pressure, high cholesterol and high triglyceride levels).
• Type 2 diabetes.
• Overweight (BMI 25 to 29.9 kilograms kg/m2).
• Obesity (BMI 30 kg/m2 and above).
• Polycystic ovary syndrome (PCOS).
• Obstructive sleep apnea.
• Hypothyroidism (low thyroid hormones).
• Hypopituitarism (low pituitary gland hormones).
• Hypogonadism (low sex hormones).
• Some prescription medications, such as amiodarone (Cordarone®), diltiazem (Cardizem®), tamoxifen (Nolvadex®) or steroids. (Fat buildup in your liver can be a medication side effect.)

SYMPTOMS OF FATTY LIVER

1. Abdominal pain or a feeling of fullness in the upper right side of your abdomen (belly).
2. Extreme exhaustion or weakness (fatigue).

• More commonly, people notice symptoms once SLD has progressed to cirrhosis of the liver. When cirrhosis develops, you may experience:

1. Nausea.
2. Loss of appetite.
3. Unexplained weight loss.
4. Yellowish skin and whites of the eyes (jaundice).
5. Swelling in your abdomen (ascites)
6. Swelling in your legs, feet or hands (edema).
7. Bleeding (that your provider finds in your esophagus, stomach or rectum).

ASSOCIATED PROBLEMS WITH FATTY LIVER 

1. Hepatitis: Your liver goes from fatty to inflamed (swollen). The inflammation damages tissue. This stage is called steatohepatitis. For example, this is what happens when MASLD becomes MASH.
2. Fibrosis: Bands of scar tissue form where the inflammation damages your liver, causing it to stiffen. This process is called fibrosis.
3. Cirrhosis: Extensive scar tissue replaces healthy tissue. At this point, you have cirrhosis of the liver. Without treatment, cirrhosis can lead to potentially fatal conditions like liver failure and liver cancer. About 90% of people who develop hepatocellular carcinoma (HCC) — a type of liver cancer — have cirrhosis.

FATTY LIVER RISK FACTORS 

1. Weight: overweight or obese, exessive fat around the waist 
2. Blood sugar: Type 2 diabetes or prediabetes, or high blood sugar 
3. Blood pressure: Having high blood pressure 
4. Blood fat: Having high levels of cholesterol or triglycerides in the blood 
5. Age: Being middle-aged or older 
6. Metabolic syndrome: Having a combination of diabetes, high blood pressure, and obesity 
7. Medications: Taking certain drugs, such as corticosteroids, synthetic estrogens, amiodarone, methotrexate, and tamoxifen 
8. Infections: Having certain infections, such as hepatitis C 
9. Toxins: Being exposed to certain toxins 
10. Rapid weight loss: Experiencing rapid excessive weight loss 
11. Sleep apnea: Having obstructive sleep apnea (OSA), a chronic intermittent breathing cessation 
12. Genetic risk factors: Having certain genetic risk factors 
13. Polycystic ovarian syndrome (PCOS): Suffering from PCOS

FATTY ACID TREATMENTS

FATTY ACID STATISTICS

About 10% of children in the U.S. have NAFLD – and numbers are growing as the number of obese kids grows. NAFLD is also more common in: