How fat is your liver?

Silent worker

Like we pay attention to our heart and lungs, it's equally important to give credit to the humble liver, as it's imperative for our good health, writes Dr C Vikram Belliappa

 

When it comes to giving credit for keeping us fit and healthy, the humble liver does not find itself any acknowledgement. Liver, the second largest organ in the body, is a big chemical factory that accomplishes many important tasks. It is responsible for metabolism of cholesterol and fats, detoxification of potentially harmful substances, processing and elimination of medications and regulation of various hormones. It also stores sugar for energy, iron for red blood cell production and some essential vitamins.

With growing obesity, especially childhood obesity, cases of fatty liver are emerging as a major public health burden. Estimates suggest that around 30 percent of general population suffer from fatty liver and this figure increases up to 80 per cent in diabetics and obese patients. In fact, it is expected that fatty liver-related cirrhosis will the most common cause for liver transplantation by 2020.

The bad fat

Non-Alcoholic Fatty Liver Disease (NAFLD) is characterised by increased accumulation of fat, especially triglycerides, in the liver cells. It is normal for the liver to contain some fat and by itself, this causes no symptoms. In some patients, the excess fat can cause inflammation called steatohepatitis, although there is no relationship between the amount of fat present and the potential for inflammation. Steatohepatitis can lead to cirrhosis (fibrosis, scarring and hardening of the liver). There is also an association with liver cancer. The fatty liver has a yellow greasy appearance and is often enlarged and swollen with fat. This fatty infiltration slows down the metabolism of body fat stores, which means that the liver burns fat less efficiently, resulting in weight gain.

However, some people can have a fatty liver without being overweight. Fatty liver is usually associated with abdominal obesity, incorrect diet, alcoholism and insulin resistance and is more common in people with type 2 diabetes. Other causes can be malnutrition, congenital metabolic disorders and excessive use of or toxicity of prescribed medications and painkillers.

Many people with a fatty liver are unaware that they even have a liver problem, as the symptoms are not very clear or specific, especially in the early stages. Most common symptoms include excess weight in the abdominal area, inability to lose weight, elevated cholesterol and/or triglyceride levels, fatigue, nausea and/or indigestion, and discomfort over the liver area (right upper abdomen). Diagnosis is done by checking for elevated live enzymes on a blood test for liver function and liver ultrasound scan. To keep fatty liver in check, eat less carbohydrate-rich food, drink less alcohol, eat more vegetables, proteins and the right fats and improve your metabolism through exercise.

(The author is a consultant surgical gastroenterologist, Vikram Hospital, Bengaluru)