Fatty liver can progress with inflammation, called nonalcoholic steatohepatitis or NASH, which leads to scar tissue buildup or fibrosis. Increasing amounts of fibrosis becomes cirrhosis of the liver and leads to increased rates of liver cancer, and well as death from liver failure, heart attacks and strokes. In addition to belly fat (central obesity = visceral adiposity), the presence of insulin resistance and type 2 diabetes dramatically increases the risk for more severe liver damage and liver scarring.
The diagnosis of fatty liver or NASH can be challenging because there is no effortless way to distinguish liver fat from liver fibrosis. Testing requires liver screening scores (most commonly, FIB-4), enhanced liver testing (ELF) imaging with ultrasound and a test called Fibroscan which can be performed in some doctors’ offices. Liver biopsy is the gold standard method of determining if there is fibrosis or cirrhosis, but biopsy is invasive and can have risks, and is still not a perfect test. Weight loss is the best treatment of fatty liver disease, however weight loss from diet and exercise is usually unsustainable and does not come close to the levels of weight loss seen from bariatric surgery. A new study has given us important evidence-based data guiding the treatment of fatty liver disease in patients who are very overweight.
The study analyzed liver disease outcomes as well as cardiovascular health in over one thousand patients with fatty liver disease compared to bariatric surgery or standard medical therapy. Bariatric surgery reduced major undesirable liver consequences by 12.4% and adverse cardiovascular incidents (heart attacks and strokes) by 13.9%. This study confirms the importance of significant weight loss as a treatment of fatty liver disease and for the reduction of cardiovascular disease related to fatty liver disease. Fatty liver is underdiagnosed, especially in high-risk populations such as those with type 2 diabetes, prediabetes, obesity, PCOS or the metabolic syndrome. Doctors need more screening and earlier detection of fatty liver disease to initiate treatments including weight-loss efforts, medications, and bariatric surgery.
