'Fatty Liver Disease Not Always Benign', Warns Leading Gastroenterologist

Dr. Mahesh Goenka explains the basics of Fatty Liver Disease and calls for vigilance, not panic

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Priyam Marik   |  TT:  

A few years ago, fatty liver disease (FLD), wherein excess fat builds up in the liver, was considered to be a mostly benign ailment among the medical community. But that perception has undergone a “paradigm shift” in recent times, according to Dr Mahesh Goenka, director, Institute of Gastro Sciences and Liver Transplant, Apollo Gleneagles Hospitals, Kolkata.

Dr Goenka believes that a fatty liver, which was long believed to have mild or moderate effects on health, if neglected, can lead to serious consequences in a “significant number of cases”.

A common problem in a country like India, FLD is said to affect around 10 to 20 per cent of the population, or one in every five to 10 people. 

“Fatty liver disease means that the normal composition of fat in the liver, which is usually up to 5 per cent, has increased. Fatty liver disease can be caused by alcohol, by viruses, by various drugs, like painkillers or those used to treat heart diseases, psychiatric diseases and so on. Once you rule out these causes, then the fatty liver disease can be called non-alcoholic fatty liver disease. This non-alcoholic fatty liver disease is often associated with other disorders like diabetes, obesity, hypertension, cholesterol abnormalities, etc. and they together constitute what is known as metabolic syndrome. So, if somebody has obesity, diabetes, hypertension or dyslipidemia, one should look out for fatty liver disease,” observed Dr Goenka.

While many FLD patients tend to be overweight or obese, it is not unlikely to find lean individuals, especially in India, having a fatty liver due to genetic, hormonal, or other medical or biological factors.

“Fatty liver disease often does not manifest and may be totally asymptomatic. We may still suspect it when you get an abnormal liver function test, or a diagnosis of fatty liver disease is suspected at ultrasound. Later on, the patients may develop some symptoms, which may initially be very mild, like a little discomfort in the abdomen or tiredness towards the evening,” said Dr Goenka. 

He added that a “confirmation of FLD can be sought through a brief MRI test called MRI Pdff, although in some instances, a biopsy may also be needed to clearly understand the status of the liver. Advancement to fibrosis or cirrhosis can also be detected by non-invasive tests such as elastography or fibroscan.”

In select cases, FLD can pose major liver dysfunction through decreased urine output, jaundice, and in extreme cases, liver cirrhosis, which could even lead to liver cancer.

While there are a few medicines available that retard accumulation of fat in the liver, the most advisable treatment against FLD, says Dr Goenka, involves changes in lifestyle. Exercise and weight loss are the main solutions, but in a few advanced cases, there may also be a need for a liver transplant. 

But how concerned should patients be when diagnosed with FLD? 

According to Dr Goenka, “there is no need to panic. But at the same time, patients should not be too relaxed, and should remain vigilant following a diagnosis. With our current knowledge, there is no way one should neglect this disease, as a small but definite percentage of these patients can progress to more severe disorders like liver cirrhosis or even cancer.”