Fatty Liver on and off for years - ALT Slightly Elevated?
Question:
Answer:
In general, fatty liver is a completely reversible process. If you abstain from alcohol and lose weight, your liver should regress to its previous state of health (presuming that there is no damage besides the fatty change). The problem, as you seem to be aware, is that the fatty change can lead to non-alcoholic steatohepatitis (NASH) which can in turn lead to cirrhosis. Most healthy people do not have significant fat accumulations in their livers, nor do they have recurrent elevations of liver enzymes. You should probably go see your physician and ask for a personal evaluation related to your own situation.
HAHA never heard of that
Are there other causes of fat accumulation in the liver?
Indeed, there are many other causes of fat accumulation in the liver besides NAFLD. However, NAFLD and NASH are considered the primary fatty liver diseases. The secondary fatty liver diseases include those that occur in other types of liver disease. Thus, alcoholic liver disease (ALD) is the most frequent secondary fatty liver disease. Secondary fatty liver can also occur in chronic viral hepatitis C (HCV), chronic viral hepatitis B (HBV), chronic autoimmune hepatitis (AIH), and Wilson's disease. (In AIH, the body's immune defense system mistakenly attacks its own liver. In Wilson's disease, an accumulation of copper injures the liver.) In all of these secondary fatty liver diseases, fatty liver is associated with other liver abnormalities distinct from NAFLD and is thought to result from liver cell injury.
Another type of secondary fatty liver disease is unrelated to other specific liver diseases. In these cases, the accumulation of liver fat is due to disturbances in the body's processing (metabolism) of fat (lipid) rather than to direct injury to the liver cells. Such causes include certain drugs (e.g., prednisone), some gastrointestinal operations (bariatric surgery) for obesity, malnutrition, and genetic defects in proteins that process (metabolize) lipids. As described below, all of the secondary causes of fatty liver disease must be ruled out before attempting to establish the diagnosis of NAFLD. This is why NAFLD is considered a diagnosis of exclusion.
How long have we known about NAFLD and NASH?
Liver specialists (hepatologists) actually recognized what is now called NASH in the 1970's, but it was described under different names. In 1980, Dr. J. Ludwig from the Mayo Clinic in Rochester, Minnesota made an astute observation. He noted that certain individuals who share common features (obesity, diabetes, and elevated cholesterol) had a liver disease that closely resembled alcoholic liver disease (ALD). However, these patients drank no alcohol whatsoever. So, Dr. Ludwig was the first to coin the term nonalcoholic steatohepatitis (NASH). For many years, however, NASH was thought by most doctors to be a totally harmless condition. Or, it was considered an innocent bystander that was associated with other liver diseases (especially viral hepatitis). In fact, during those years, simple fatty liver (steatosis) and NASH were considered to be equivalent processes.
The discovery of the hepatitis C virus (HCV) played an accidental role in the recognition of the clinical significance of NASH. Up until 1990, individuals who had hepatitis with signs similar to those of viral hepatitis A or B (but with negative blood tests for both) were said to have non-A-non-B viral hepatitis. Then, in 1990 the hepatitis C virus was discovered. In the years that followed, the ways by which HCV is spread (blood transfusion and intravenous drug use) and its effects on the liver were recognized. It turned out that a great majority of non-A-non-B viral hepatitis cases were in fact due to HCV. There remained, however, some individuals whose tests were negative for HCV as well as for other types of liver disease. Only then did researchers realize that for many of these individuals, NASH was the culprit. This realization has since led to a flurry of interest and research regarding NASH and to the understanding that it is not a harmless condition.
Clinical studies and basic research on NAFLD are still in their infancy as compared to other common liver diseases, such as ALD and HCV. As a result, we continue to have an incomplete understanding of the natural history of NAFLD. Moreover, we do not know much about the processes responsible for the progression from simple fatty liver to NASH and NASH to cirrhosis.
What are Fatty Liver, NAFLD, and NASH?
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes). In NASH, the fat accumulation is associated with varying degrees of inflammation (hepatitis) and scarring (fibrosis) of the liver.
The term nonalcoholic is used because NAFLD and NASH occur in individuals who do not consume excessive amounts of alcohol. Yet, in many respects, the histological picture of NAFLD (when we look at a biopsy piece of liver under the microscope) is similar to what can be seen in liver disease that is due to excessive intake of alcohol. As we shall see, however, the clinical circumstances in NAFLD and NASH are very different from those in alcoholic liver disease (ALD).
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