Degrees of fatty liver, symptoms and how to treat

The accumulation of fat in the liver, technically called hepatic steatosis, is a very common problem that can be caused by risk factors such as obesity, diabetes, high cholesterol and excessive consumption of alcoholic beverages.

Although there are not always symptoms, it is possible that some people experience pain in the right side of the abdomen, swollen belly, nausea, vomiting and general malaise. In the presence of these symptoms, a hepatologist should be consulted to perform tests that assess the functioning of the liver and the severity of the disease. Check out some of the tests that assess liver health.

Liver fat can be controlled with changes in diet and regular physical exercise, it is important to follow the appropriate treatment to avoid complications such as cirrhosis.

Degrees of hepatic steatosis

Liver fat can be classified according to its severity into:

• Grade 1 or Simple hepatic steatosis: excess fat is considered harmless. There is usually no symptom and the problem is only discovered through a routine blood test; Grade 2 or non-alcoholic hepatic steatosis: in addition to excess fat, the liver becomes inflamed, which can lead to the appearance of some symptoms such as pain in the right side of the abdomen and a swollen belly; Grade 3 or Liver fibrosis: there is fat and inflammation that cause changes in the organ and blood vessels around it, but the liver still functions normally; Grade 4 or Liver cirrhosis: it is the most severe phase of the disease and appears after years of inflammation, being characterized by changes in the entire liver that causes a reduction in its size and leaves its irregular shape. Cirrhosis can progress to cancer or death of the liver, requiring an organ transplant.

Thus, in addition to assessing the amount of fat in the organ, it is also important to check for the presence of inflammation, as it is the main cause of cell death in this organ. To assess the progression of the disease, the doctor may indicate the performance of hepatic elastography, which is a quick and painless examination and which is very effective in monitoring people with liver disease. Understand how liver elastography is done.

Main symptoms

Normally, during the early stages of the disease, there is no symptom whatsoever, which is why steatosis is often discovered accidentally through tests to diagnose other diseases.

However, in the more advanced stages, pain may appear in the upper right side of the abdomen, unexplained weight loss, tiredness and general malaise, with nausea and vomiting, for example. In cases of cirrhosis, other symptoms can also appear, such as yellow skin and eyes, itchy body and swelling in the belly, legs and ankles. Check a more complete list of the symptoms of fatty liver.

Main causes of hepatic steatosis

The causes of fat in the liver are still not well understood, however the mechanism that leads to the onset of the disease is the subject of several researches today. It is believed that the accumulation of fat in the liver is related to the imbalance between the consumption and synthesis of fat by the body and its use and elimination. This imbalance, in turn, could be related to genetic, nutritional and environmental factors.

Although the causes are not yet known, the risk of developing fat in the liver is much higher in people who consume alcoholic beverages, and it can be increased when there are other risk factors, such as:

• Obesity; Type 2 diabetes; High blood pressure; High cholesterol; Age over 50 years; Being a smoker; Having hypothyroidism.

In addition, bariatric surgery and other weight loss procedures increase the risk of developing liver fat due to changes in metabolism caused by rapid weight loss. However, this problem can also arise in people who have no risk factor, and can even affect children and pregnant women.

How to confirm the diagnosis

Changes in the liver can be detected initially through a blood test that evaluates the substances produced by that organ. And, if there are altered values, which indicate that the liver is not working well, the doctor may order additional tests such as ultrasound, tomography, liver elastography, magnetic resonance imaging or a biopsy.

However, it is important to note that fat in the liver does not always cause changes in blood tests, which can delay the diagnosis of the disease until the patient has an ultrasound scan to investigate other problems.

Better understand how to reach the diagnosis

The presence of hepatic steatosis is not always represented by changes in the hepatogram, and the results that assess the presence of cell damage, cholestasis and liver function should be taken, as described below:

Examinations of hepatocellular lesion

Transaminases are released into the blood after liver damage. AST, formerly known as TGO, is produced in the liver, kidneys and muscle, and its elevated levels are more linked to liver damage, while ALT, formerly called TGP, is also expressed in the heart, muscle and erythrocytes.

Alkaline phosphatase is produced in the placenta, kidney, intestine and leukocytes, and may also be increased during adolescence and pregnancy. Finally, gammaglutamyl transpeptidase, acronym GGT, can be found in the renal tubules, liver, pancreas and intestine.

Liver function tests

To assess liver function, the results of albuminemia, bilirubinemia and prothrombin time, important products that reflect the functioning of the liver, should be checked.

Diagnostics

The presence of changes in liver tests may indicate:

• Alcoholic Liver Disease: The AST / ALT ratio is typically 2: 1 or higher. In cases of unreliable medical history, normal results of alkaline phosphatase, elevated GGT and macrocytosis suggest this diagnosis; Chronic Viral Hepatitis: causes changes in several parameters of liver function; Autoimmune hepatitis: appears mainly in young and middle aged women with autoimmune diseases, such as rheumatological problems and autoimmune thyroid. Liver steatosis: most common cause of changes in liver function, but its diagnosis is exclusion. Observe the presence of obesity, diabetes and dyslipidemia, with biopsy being the safest means of diagnosis. Ischemic hepatitis: appears in cases of low circulatory volume, such as hypotension and hemorrhage, and has elevated ALT, AST and lactate dehydrogenase. Toxic hepatitis: identified mainly by collecting a complete patient history, but the most frequent cause of paracetamol overdose. Cholestatic liver damage: slightly elevated AST and ALT, along with increased alkaline phosphatase and GGT.

If the patient has no symptoms and all initial evaluations are negative, start treatment with lifestyle changes, weight loss, control of comorbidities and suspension of potentially hepatotoxic drugs, such as Amiodarone.

The exam must be repeated after 6 months, and in case of persistence of the changes, perform an ultrasound, and it may be necessary to prescribe complementary exams such as tomography and biopsy.

How the treatment is done

Treatment for fat in the liver is done mainly with changes in diet, regular exercise and the elimination of alcohol consumption. In addition, it is also necessary to lose weight and control diseases that worsen the problem, such as diabetes, hypertension and high cholesterol, for example. Here's an example of what the liver fat diet should look like.

There are no specific remedies to treat fatty liver disease, but your doctor may recommend hepatitis B vaccines to prevent more liver disease. Some home remedies can also be used to aid treatment, such as tea thistle or artichoke tea, it is important to first ask your doctor's permission before using them.

The following video provides tips from our nutritionist to control and reduce liver fat: