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Rise in Fatty Liver Disease

Obesity, Sedentary Lifestyles, and Alcohol to Blame

New York (Oct 20, 2010)

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It's well known that obesity is increasing at an alarming rate in the United States, fueled by over-sized food portions, over-scheduled families who rely on fast-food chains for dinner, and a scarcity of daily physical activity. Diabetes incidence is on the rise as well. These trends are also contributing to an escalation in the diagnosis of another worrisome illness: fatty liver disease.

Fatty liver disease affects as many as one in five adults and, with the rise in pediatric obesity, one in 20 children in America. Most of the time, it does not develop into a life-threatening problem. But it can progress to inflammation, and in some patients, cirrhosis. About half of all patients with cirrhosis had fatty liver disease, which is being increasingly recognized as a leading cause of liver-related morbidity and mortality.

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When the cirrhosis becomes so advanced that it severely compromises liver function, the patient may even need a liver transplant. "The number of patients who need a liver transplant as a result of fatty liver disease could possibly surpass the number of people who need a transplant because of hepatitis C," noted Scott Fink, M.D.

Scott A. Fink, M.D.
Scott A. Fink, M.D.

While there are ways to reverse early fatty liver disease and to reduce the risk, there is no proven cure. A low-fat diet and exercise are the best defenses. NewYork-Presbyterian offers outpatient evaluation and comprehensive care for patients with fatty liver disease, and also offers liver transplantation for those in need.

Because alcohol abuse can also cause fatty liver disease, physicians should estimate the extent of alcohol use in patients suspected to have this illness. Individuals with the illness who don't have a history of alcohol abuse are often obese and have metabolic syndrome. Fatty liver disease that progresses to inflammation, causing non-alcoholic steatohepatitis, is also rising in incidence in this country. In some cases, however, the illness develops in someone without any known risk factors.

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Fatty liver disease often causes no symptoms. Routine blood tests may show elevations in certain liver enzymes. Serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels should be measured, and liver function (serum bilirubin, albumin, and prothrombin) should be assessed.

Sonja K. Olsen, M.D.
Sonja K. Olsen, M.D.

Fatty liver disease may be suspected in a patient who complains of fatigue and abdominal pain and whose liver feels enlarged upon examination. Sonography or CT scanning can be used to assess the liver, but only a liver biopsy can confirm a diagnosis of fatty liver disease. Because there is no way to diagnose fatty liver disease other than by biopsy, researchers are trying to develop non-invasive diagnostic blood tests.

Once a patient is diagnosed with fatty liver disease, lifestyle changes are in order to try to reverse it and keep it from progressing to cirrhosis. "The only proven therapy and the gold standard is weight loss," explained Sonja Olsen, M.D.

Patients should be advised to adopt a low-fat diet and increase the amount of physical activity in their lives. And as with all liver diseases, they must abstain from consuming alcohol. Clinical trials have been conducted to assess the value of diabetes drugs (such as metformin and pioglitazone), but the results have not been conclusive. "We're awaiting the results of large-scale studies to assess the benefits of these drugs," said Dr. Fink.

The care of patients with fatty liver disease requires a multidisciplinary team of endocrinologists, hepatologists, primary care physicians, and nutritionists. This is the approach taken by the specialists at NewYork-Presbyterian. Concluded Dr. Olsen, "All of these individuals collaborate to present a consistent message to the patient."

Contributing faculty for this article:

Sonja K. Olsen, M.D. is an Assistant Attending Physician at NewYork-Presbyterian/Weill Cornell Medical Center and an Assistant Professor of Medicine at Weill Cornell Medical College.

Scott A. Fink, M.D. is an Assistant Attending Physician at NewYork-Presbyterian/Columbia University Medical Center and an Assistant Professor of Medicine (in Surgery) at Columbia University College of Physicians and Surgeons.

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