Fatty Liver disease

How severe is a grade 3 fatty liver?

  • Hepatomegaly with fatty liver grade 3 is the sonography assessment of the liver.
  • Just like you don't judge a book by its cover, you cant judge the liver purely on basis of sonography.
  • Unfortunately, the sonographic grading (grade 3 in this case) does not correspond to the actual severity.
  • It takes a corroboration of clinical findings, biochemical tests like LFT, sonography and in some cases special tests to get the complete picture.

How much time does it take to reverse fatty liver grade 2?

  • Grade 2 fatty liver is a sonographic severity of the amount of fat deposition in the liver. It does not correlate to the actual severity.
  • Treatment consists of lifestyle interventions.
  • Medications are required in a some patients.
  • Reversal of fatty liver can occur in 6–12 months if proper lifestyle changes and medications are followed. Treatment may go on for 2 years in some patients. But the lifestyle changes have to be applied for a lifetime.

How do I know what stage my fatty liver is?

  • The two main causes of fatty liver are:
  • NAFLD is further divided into NAFL (simple fatty liver) and NASH (steatohepatitis).
  • Alcohol and
  • NAFLD- Non alcoholic fatty liver disease
  • The underlying cause of NAFLD is a faulty lifestyle and is a part of metabolic syndrome (consisting of obesity, hypertension, high sugar, elevated lipids)
  • NAFL is only fatty liver with normal enzymes. NASH consists of inflammation in the liver with high enzymes (SGOT and SGPT).
  • NASH is further divided into stages based on amount of inflammation and degree of fibrosis. Fibrosis is from F0 meaning none to F4 meaning cirrhosis.
  • The best method to stage the fatty liver is a liver biopsy. But it is invasive and can lead to complications.
  • There are indirect methods to stage it. You can predict stage based on your platelets, LFT, INR, GGT, ultrasound and fibroscan.
  • Please consult a gastroenterologist/ hepatologist to help you.
  • Early intervention is successful before permanent damage sets in.

How much time does it take from Fatty liver to Cirrhosis?

  • NASH: Non- alcoholic steatohepatitis
  • HCC: Hepatocellular carcinoma
  • The progression is slow. There are four stages of fibrosis from fatty liver to cirrhosis. Each stage takes approximately 7 years (in another study). But 10% of people are rapid progressors and reach cirrhosis faster.
  • NAFLD- Non alcoholic fatty liver disease
  • The underlying cause of NAFLD is a faulty lifestyle and is a part of metabolic syndrome (consisting of obesity, hypertension, high sugar, elevated lipids)
  • NAFL is only fatty liver with normal enzymes. NASH consists of inflammation in the liver with high enzymes (SGOT and SGPT).

How can one cure a fatty liver?

  • A change in lifestyle is effective in reversing fatty liver. There is no need to go for medicines of any discipline. The root cause of fatty liver is either alcohol or sedentary lifestyle. Adherence to a exercise regime and a balanced diet is the mainstay of the treatment. This is important as we have to target the root cause. This will also have a positive impact on other areas like obesity, high sugar, BP problems, sleep problems etc which also have their root cause in a faulty lifestyle.
  • Ideal goals to reverse fatty liver:
  • At least 7% weight loss
  • 500 kcal deficit in daily energy consumption (This target is better than consuming a diet of a fixed amount of calories)
  • 150-200 min/week of moderate intensity aerobic physical activity
  • A number of medications are also available to help reverse fatty liver and have a complimentary role to lifestyle modifications.

What does it mean when someone has a grade 2 fatty liver on an ultrasound but the LFT is normal?

  • The two main causes of fatty liver are:
  • Alcohol
  • NAFLD- Non alcoholic fatty liver disease
  • The underlying cause of NAFLD is a faulty lifestyle and is a part of metabolic syndrome (consisting of obesity, hypertension, high sugar, elevated lipids)
  • NAFLD is further divided into NAFL (simple fatty liver) and NASH (steatohepatitis).
  • NAFL is only fatty liver with normal enzymes.
  • NASH consists of inflammation in the liver from the fat deposition with high enzymes (SGOT and SGPT).
  • NASH is further divided into stages based on amount of inflammation and degree of fibrosis. Fibrosis is from F0 meaning none to F4 meaning cirrhosis.
  • The best method to stage the fatty liver is a liver biopsy. But it is invasive and can lead to complications.
  • There are indirect methods to stage it. You can predict stage based on your platelets, LFT, INR, GGT, ultrasound and fibroscan.
  • Based on your reports of fatty liver with normal LFT, the likely diagnosis is NAFL (simple fatty liver). This can progress to NASH, but if corrective measures are taken it can regress to normal too.
  • Remember, grade 2 is the sonographic grading of fatty liver and this does not correlate with actual severity of the fatty liver disease.
  • Doctors treat the patient and not the reports.