This is a condition that is occurring with increasing frequency and involves the accumulation of fat inside liver cells. Fat accumulation in liver cells can occur in persons who drink alcohol to excess but "Fatty Liver" also called "Non-Alcoholic Fatty Liver Disease" or "NAFLD" occurs in persons who do not drink alcohol to excess. The most definitive way to determine if a person has Fatty Liver is to take a piece of liver tissue for analysis - a Liver Biopsy. However, this procedure carries a small risk of serious, life threatening bleeding and anyway currently losing weight is the only treatment we have to offer. We therefore try to make a diagnosis of Fatty Liver or NAFLD non-invasively as best as we can. The diagnosis is usually suggested on an Ultrasound or other Imaging study of the liver or when blood tests show slight elevation of liver tests. When an Ultrasound is done, sound waves are sent into the liver. Some of these will pass through and some will bounce back. Fat in the liver typically causes more of the waves to bounce back, typically in a patchy manner. This is referred to as a "heterogenous increase in liver echogenicity". While the majority of persons with such an increase in echogenicity have fatty liver, viral infections and other conditions - including rarely cancer in the liver can cause such an appearance. We typically do blood tests and a general examination to look for these other conditions and if they are not seen, we make a presumptive diagnosis of fatty liver. Fatty liver can exist for many years without causing apparent damage to the ability of the liver to function, but in some persons - we cannot accurately predict who - can results in irreversible death of liver cells and inflammation - this is called "Non-Alcoholic Steato-Hepatitis" or NASH ("Steato" means Fat and "Hepatitis" means inflammation of the liver) and even irreversible death of liver cells with replacement of functioning liver cells by scar tissue - this is called "Cirrhosis". NASH increases the risk of future cirrhosis. If severe enough, cirrhosis can cause liver failure even resulting in need for a liver transplant.

Our approach to managing patients is based on an assessment of "probability of risk" vs "probability of benefit". We make decisions based on likelihood of a certain condition existing and its consequence and the likelihood of causing harm with tests and procedures we may have to do. We are also guided by what we know about the likely future course of different conditions. For example, we would like to avoid irreversible damage/scarring of the liver - that is cirrhosis. But we do not do liver biopsies to know with more certainty because IF a person had cirrhosis we do not have a specific treatment to offer - unless the disease is very advanced when we have to take actions which will themselves entail risk. The good thing is that the liver has a lot of reserve, so a little bit of damage may not affect a person very much, though we would like to prevent further damage, since the reserve will at one point be exhausted.

Again, the only treatment we can currently suggest is that persons try hard to maintain ideal body weight. If diabetic, we suggest good control of that condition. We also suggest avoiding alcohol. Unfortunately, fatty liver can occur even in persons who are not overweight or diabetic. We don't know for sure why, but some researchers think additives in the diet - eg high fructose corn syrup may be responsible. Since additives like these are so widely used, it is hard to know for sure. We suggest eating a diet with simple ingredients - organically grown - if possible in the backyard - though we cannot be sure if such an approach will prevent or reverse fatty liver.

Fatty liver and especially NASH and certainly cirrhosis, increase the risk of liver cancer. We therefore monitor persons with fatty liver every 6 months with an Ultrasound of the liver and blood tests. This approach does not guarantee that we will pick up a cancer early, but is felt to be the best practice with the current state of knowledge.

The link below from the American Liver Foundation has more information - including some in Spanish