Nonalcoholic fatty liver disease NASH definition facts. What is fatty liver disease? What is nonalcoholic liver disease NASH? Fatty liver is a condition in which the cells of the liver accumulate abnormally increased amounts of fat. Although excessive consumption of alcohol is a very common cause of fatty liver alcoholic fatty liverthere is another form of fatty liver, termed nonalcoholic fatty liver disease nonalcoholic fatty liver diseasein which alcohol has been excluded as a cause.
In nonalcoholic fatty liver disease, other recognized causes of fatty liver that are less common causes than zoloft and liver problems also are excluded. Nonalcoholic fatty liver disease is a manifestation of an abnormality of metabolism within the liver. The liver is an important organ in the metabolism handling of fat.
The liver makes and exports fat to other parts of the body. It also removes fat from the blood that has been released by other tissues in the body, for example, by fat cells, or absorbed from the food we eat. In nonalcoholic fatty liver disease, the handling of fat by liver cells is disturbed.
As a result, fat accumulates in the liver. Nonalcoholic fatty liver disease is classified as either fatty liver sometimes referred to as isolated fatty liver or IFL or steatohepatitis NASH. In both isolated fatty liver and NASH there is an abnormal amount of fat in the liver cells, but, in addition, in NASH there is inflammation within the liver, and, as a result, the liver cells are damaged, they die, and are replaced by scar tissue.
What are the signs and symptoms of fatty liver disease? Fatty liver disease rarely causes symptoms until the liver disease is far advanced. Fatty liver usually is found or suspected when:. When the liver disease is far advanced cirrhosissigns and symptoms of cirrhosis predominate. The cause of nonalcoholic fatty liver disease is complex and not completely understood. The most important factors appear to be the presence of obesity and diabetes. It used to be thought that obesity was nothing zoloft and liver problems than the simple accumulation of fat in the body.
Fat tissues were thought to be inert, that is, they served as simply storage sites for fat and had little activity or interactions with other tissues.
We zoloft and liver problems know that fat tissue is very active metabolically and has interactions and effects on tissues throughout the body. When large amounts of fat are present as they are in obesity, the fat becomes metabolically active actually inflamed and gives rise to the production of many hormones and proteins that are released into the blood and have effects on cells throughout the body. One of the many effects of these hormones and proteins is to promote insulin resistance in cells.
Insulin resistance is a state in which the cells of the body do not respond adequately to insulin, a hormone produced by the pancreas. Insulin is important because it is a major promoter of glucose sugar uptake from the blood by cells. At first, the pancreas compensates for the insensitivity to insulin by making and releasing more insulin, but eventually it can no longer produce sufficient quantities of insulin and, in fact, may begin to produce decreasing amounts, zoloft and liver problems.
At this point, not enough sugar enters cells, and it begins to accumulate in the blood, a state zoloft and liver problems as diabetes. Although sugar in the blood is present in large amounts, the insensitivity to insulin prevents the cells from receiving enough sugar. Since sugar is an important source of energy for cells and allows them to carry out their specialized functions, the lack of sugar begins to alter the way in which the cells function.
In zoloft and liver problems to releasing hormones and proteins, the fat cells also begin to release some of the fat that is being stored in them in the form of fatty acids. As a result, zoloft and liver problems, there is an increase in the blood levels of fatty acids. This is important because large amounts of certain types of fatty acids are toxic to cells.
The release of hormones, proteins, and zoloft and liver problems acids from fat cells affects cells throughout the body in different ways. Liver cells, like many other cells in the zoloft and liver problems, become insulin resistant, and their metabolic processes, zoloft and liver problems, including their handling of fat, become altered. The liver cells increase their uptake of fatty acids from the blood where fatty acids are in abundance, zoloft and liver problems.
Within the liver cells, the fatty acids are changed into storage fat, and the fat accumulates. At the same time, the ability of the liver to dispose of or export the accumulated fat is reduced. In addition, the liver itself continues to produce fat and to receive fat from the diet. The result is that fat accumulates to an even greater extent. Can obesity and diabetes cause NASH? As previously mentioned, obesity and diabetes have important roles in the development of fatty liver.
Whereas one third of the general population which includes obese and people with diabetes may develop nonalcoholic fatty liver disease, more than two thirds of people with diabetes develop nonalcoholic fatty liver disease.
Among patients who are very obese and undergoing surgery for their obesity, the majority have nonalcoholic fatty liver disease.
Fatty liver increases both in prevalence as well as severity as the degree of zoloft and liver problems increases, zoloft and liver problems. The increases begin at weights that are considered overweight - i. Can metabolic syndrome cause NASH? Metabolic syndrome is a syndrome defined by the association of several metabolic abnormalities that are believed to have a common cause.
These metabolic abnormalities result in:. Nonalcoholic fatty liver disease is considered a manifestation of metabolic syndrome and thus occurs frequently with the other manifestations of the syndrome. Occasionally, it may occur without the other abnormalities of the syndrome. Can alcohol or drug abuse cause NASH? Several identifiable causes of fatty liver that are not nonalcoholic fatty liver disease so often causes confusion.
The most common causes of nonalcoholic fatty liver disease are excessive alcohol consumption and hepatitis C. Can NASH occur in children? Since the current epidemic of obesity begins in childhood, it is not surprising to find that nonalcoholic fatty liver disease occurs in children. Although there is concern about nonalcoholic fatty liver disease among children, zoloft and liver problems, there is not enough evidence of benefit of treatment, zoloft and liver problems, and, therefore, no general recommendation has been made to screen zoloft and liver problems and obese children for nonalcoholic fatty liver disease.
It is recommended, however, that children with suspected nonalcoholic fatty liver zoloft and liver problems in whom the diagnosis is not clear should have a liver biopsy. Children should zoloft and liver problems be started on any drug treatment for nonalcoholic fatty liver disease without a biopsy showing NASH.
Although there have not been studies in children to support the recommendations, loss of weight and exercise are the recommended treatment for children with nonalcoholic fatty liver disease. Is fatty liver disease serious? What procedures and tests diagnose NASH?
As previously discussed, fatty liver generally does not cause symptoms or signs, zoloft and liver problems, and any symptoms and signs are more likely to be due to the accompanying diseases such as obesity, diabetes, vascular diseaseetc.
In anyone with obesity or diabetes, fatty liver should be suspected. In a minority of patients, abnormal liver tests are found on routine blood testing although the abnormalities usually are mild. Probably the most common method by which nonalcoholic fatty liver disease is diagnosed is by imaging studies like ultrasonography, computerized tomography CTand magnetic resonance imaging MRI ; that are obtained for reasons other than diagnosing nonalcoholic fatty liver disease.
Nonalcoholic fatty liver disease also may be discovered when patients develop complications of the liver disease - cirrhosis, liver failure, and liver cancer - due to the presence of NASH. It is not possible to distinguish between isolated fatty liver and NASH with imaging studies. Although a combination of several blood tests has been suggested as a means of separating the two, and tests are being developed to identify NASH, biopsy of the liver is the best means to differentiate between the presence of fat, or fat and inflammation NASH.
Although the majority of individuals will have isolated fatty liver and not NASH, it is important to identify patients with NASH, because of the need to look for complications of liver disease and to enter these patients into trials of treatment with the hope of preventing progression of the liver disease.
Patients with the metabolic syndrome, obesity, and diabetes are good candidates to undergo biopsy of the liver since the incidence of NASH is higher among these groups.
One of the difficulties in diagnosing NASH as the cause of severe scaring or cirrhosis is that as the scaring progresses to cirrhosis, the fat disappears. This results in a condition that is referred to as cryptogenic cirrhosiscirrhosis in which there is no clear cause. Specifically, in cryptogenic cirrhosis the two most common causes of cirrhosis - alcohol and viral hepatitis - are not involved, zoloft and liver problems.
Cryptogenic cirrhosis has puzzled physicians for many years as to its cause. What zoloft and liver problems the treatment for NASH? Which foods and supplements should be avoided? Can you drink alcohol? Nonalcoholic fatty liver disease has been associated in human or animal studies with reduced amounts of unsaturated fats a diet high in saturated fat and increased amounts of fructose which is most commonly added to the diet as high-fructose corn syrup.
Benefits of increasing unsaturated fat a diet lower in saturated fat, and higher unsaturated fat and reducing high fructose corn syrup on nonalcoholic fatty liver disease have not been demonstrated; however, there is little harm in doing so, especially since there may be benefits of these dietary modifications unrelated to the liver.
An interesting zoloft and liver problems - though unexplained - is that there is less scarring fibrosis in the livers zoloft and liver problems patients with NASH who drink more than two cups of coffee per day. Scarring or fibrosis is the process that ultimately leads to cirrhosis.
Similar benefits of coffee have been associated with lesser degrees of liver disease in both alcoholic cirrhosis and hepatitis C, zoloft and liver problems. It is zoloft and liver problems unreasonable to recommend drinking coffee in moderate amounts in view of the lack of harmful side effects. Vitamin D deficiency is associated with nonalcoholic fatty liver disease. Although there is no reason to think that this deficiency contributes to nonalcoholic fatty liver disease, it is reasonable to measure vitamin D levels in patients with nonalcoholic fatty liver disease and treat them with vitamin D if they are deficient.
There is no evidence of harmful effects of light alcohol consumption two or fewer drinks per day for men, one or fewer for women on nonalcoholic fatty liver disease though there also is no evidence that it is safe. Everyone, including individuals with nonalcoholic fatty liver disease should avoid drinking large amounts of alcohol.
Weight loss and exercise for NASH. Since the serious complications of nonalcoholic fatty liver disease are primarily seen in patients with NASH, treatment of NASH is of great importance. One of the difficulties in identifying effective treatments is the need for long-term studies since the progression of NASH to cirrhosis and its complications occurs slowly.
Several treatments have resulted in a reduction of fat in the liver, but few have shown that the progression of NASH is slowed, zoloft and liver problems. Weight loss and exercise are among the most promising of treatments for nonalcoholic fatty liver disease.
It does not zoloft and liver problems large amounts of weight loss to result in a decrease in liver fat. Vigorous exercise results in a reduction of liver fat and may reduce the inflammation of NASH. The long-term effects of weight loss and exercise on the important development of cirrhosis and its complications are unknown. Nevertheless, now, the best theoretical approach to nonalcoholic fatty liver disease is weight loss and vigorous exercise. Unfortunately, only a minority of patients are able to accomplish these.