Fatty Liver Disease: Risks, Diagnosis, and Possible Treatments

THE non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition — already affecting around 20% to 30% of the world’s population — and its prevalence is directly associated with increase in cases of obesity and metabolic syndrome. Understand below the main risks of the disease, how it is diagnosed and the solutions that multidisciplinary medicine can provide in diagnosis and monitoring.

It is characterized by the excessive accumulation of fat in the liver of people who do not necessarily consume significant amounts of alcohol. Its progression is silent and, in severe cases, can lead to complications such as liver cirrhosis and even hepatocellular carcinoma (a type of liver cancer).

Risks associated with fatty liver disease

Because it is a slow and silent process, it is common for patients not to present clear symptoms until the condition is advanced.

This may include tiredness, pain on the right side of the abdomen, or progressive changes in blood tests.

There are associated risk factors, most of which are acquired throughout life, the main ones being:

• Obesity: especially visceral fat, the fat that accumulates around the organs, is directly linked to the development of the disease;
• Type 2 Diabetes and Insulin Resistance: Insulin resistance is associated with the accumulation of fat in the liver;
• Dyslipidemia: high levels of cholesterol and triglycerides also increase the risk of developing NAFLD;
• Hypertension: High blood pressure is a common factor among patients with NAFLD.

Over time, the liver can become inflamed and fibrotic (scar tissue build-up), leading to nonalcoholic steatohepatitis, which is a more severe form of the disease.

If left untreated, fibrosis can progress to cirrhosis and even result in liver cancer.

Diagnosis of fatty liver disease

Diagnosis involves a combination of laboratory tests, imaging tests, and, in some cases, liver biopsies.

Doctors usually start by checking the blood for liver enzymes, such as transaminases, which may be elevated. However, imaging tests are essential to confirm the diagnosis and assess the severity of the disease.

• Abdominal ultrasound: one of the most common and accessible methods for identifying fat in the liver. However, it has limitations in identifying the severity of the disease or differentiating between simple steatosis and steatohepatitis;
• Liver elastography: a technique that measures liver stiffness and is useful for identifying the presence of liver fibrosis. It is a non-invasive test that helps determine the severity of fibrosis without the need for a biopsy;
• Magnetic resonance imaging (MRI): Magnetic resonance imaging can provide a more detailed image of the liver, especially with specific techniques such as proton spectroscopy, which assesses the concentration of fat in the organ.

Prevention and monitoring

Fatty liver disease is strongly associated with habits and lifestyle. The main ways to prevent the progression of the disease involve important changes in routine and health care, such as weight loss, a healthy diet and regular physical activity.

Additionally, controlling conditions such as diabetes and high cholesterol is essential.

For patients diagnosed with the disease, regular medical follow-up is crucial, including imaging tests to monitor the condition of the liver and check for progression to fibrosis or cirrhosis.

Non-alcoholic fatty liver disease is a serious condition that, if left undiagnosed and untreated, can lead to serious complications.

Fortunately, with the advancement of medical technology, we now have increasingly accurate and less invasive methods to identify the disease in its early stages and monitor its progression.

This offers patients a better quality of life and more opportunities for treatment before the disease progresses to critical stages.

If you have risk factors such as obesity or diabetes, it is important to get regular checkups and adopt a healthy lifestyle. Early diagnosis is key to avoiding complications.

Importance of multidisciplinary care

Non-alcoholic fatty liver disease not only affects the liver, but is closely related to metabolic conditions such as diabetes, dyslipidemia, and hypertension.

Therefore, its treatment requires a multidisciplinary approach, involving professionals from different areas of health who work together to provide the best management of the disease.

• Hepatologist: a specialist in liver care who is on the front line of diagnosis and treatment. He coordinates patient follow-up, ordering imaging tests, monitoring liver function, and identifying signs of disease progression, such as progression to fibrosis or cirrhosis. The hepatologist also advises on lifestyle changes and monitors the impact of associated metabolic diseases, such as diabetes and dyslipidemia.
• Oncologist: In cases where there is progression to hepatocellular carcinoma (HCC), the oncologist plays a crucial role in the treatment of liver cancer. He or she works closely with the hepatologist and interventional radiologist to develop a personalized treatment plan, which may include therapies such as transarterial chemoembolization (TACE), radioembolization, or even systemic chemotherapy in more advanced cases.
• Surgeon: For patients with advanced cirrhosis or liver cancer, a surgeon can be crucial, especially in cases where liver transplantation or tumor resection is necessary. The liver surgeon works with other specialists to decide the ideal time for surgery and to ensure that the patient’s clinical condition is stable enough for the procedure.
• Interventional radiologist: Performs image-guided liver biopsies to confirm the diagnosis and may apply minimally invasive treatments, such as chemoembolization or percutaneous tumor ablation.

Each specialist brings their expertise, ensuring that all aspects of the disease – from metabolic problems to possible oncological complications – are adequately treated.

This teamwork improves the chances of early diagnosis, prevention of complications and the application of more effective treatments.

Risk factors associated with NAFLD

NAFLD is closely related to metabolic syndrome and being overweight. Major risk factors include:

• Obesity: especially visceral fat, accumulated around the organs, is an important risk factor for hepatic steatosis;
• Insulin resistance and type 2 diabetes: responsible for changes in body fat metabolism, leading to the accumulation of fat in the liver;
• Dyslipidemia: high levels of cholesterol and triglycerides increase the risk;
• Hypertension: common among patients with NAFLD.

Diagnosis of NAFLD

The current recommendation is to screen for NAFLD in individuals with a body mass index (BMI) greater than 25 kilograms per height squared, even in the absence of other risk factors. Recommended techniques include:

• Abdominal ultrasound: initial non-invasive method to detect the presence of hepatic steatosis, but with limitations in quantifying severity;
• Liver elastography: this technique measures liver stiffness to assess fibrosis;
• Magnetic resonance imaging (MRI): recommended to quantify liver fat more accurately.

Prevention and monitoring

Lifestyle changes are essential to prevent the progression of NAFLD. Weight loss, a balanced diet and regular exercise are the main measures to prevent the disease from worsening.

The Brazilian guideline suggests the adoption of specific diets, such as the Mediterranean diet, and highlights that a weight loss greater than 7% can improve steatohepatitis and prevent the progression of fibrosis.

Importance of multidisciplinary care

The treatment of NAFLD requires a multidisciplinary approach, bringing together several specialists to ensure effective and individualized management:

• Hepatologist: specialist who leads the monitoring of NAFLD, requesting tests and monitoring the progression of fibrosis and cirrhosis.
• Oncologist: works in cases where NAFLD progresses to hepatocellular carcinoma, determining treatment options, such as chemotherapy and local therapies performed by interventional radiology.
• Surgeon: responsible for surgical interventions, such as liver transplants or tumor resection in advanced cases.
• Interventional radiologist: performs image-guided liver biopsies and minimally invasive treatments such as percutaneous tumor ablation, chemoembolization, and radioembolization.

Pharmacological and Surgical Treatment

The Brazilian guideline points out drug treatment options, including:

• GLP-1 analogues (Liraglutide and Semaglutide): recommended to improve steatohepatitis in individuals with obesity;
• Pioglitazone: indicated for patients with proven steatohepatitis, with or without fibrosis;
• Bariatric: in individuals with severe obesity (BMI greater than or equal to 35 kilos per patient’s height squared), bariatric surgery has shown effectiveness in resolving steatosis and regressing fibrosis.

Multidisciplinary care ensures that all aspects of the disease, from metabolic problems to oncological complications, are addressed appropriately.

This integrated approach improves the chances of early diagnosis, prevention of complications and successful treatment.

NAFLD, although silent, can have serious consequences if not diagnosed and treated properly.

Multidisciplinary treatment, combined with early diagnosis and the adoption of healthy habits, is the key to improving patients’ quality of life and preventing serious complications, such as cirrhosis and liver cancer.

*Text written by radiologist Felipe Roth Vargas (CRM: 155352-SP RQE Nº: 94668)

This content was originally published in Fatty liver disease: risks, diagnosis and possible treatments on the CNN Brasil website.

Source: CNN Brasil