Some of you might have come across this term before – ‘FATTY LIVER’. For some, your ultrasound reports might have introduced you to this term. Fatty liver is nothing but increased accumulation of fat in your liver. Previously, this condition was strongly attributed to alcoholism alone. When associated with alcohol consumption, it is clinically known as alcoholic liver disease. However, over the past decade or more, fatty liver has become a common finding in non-drinkers too. This type of fatty liver is known as non-alcoholic fatty liver disease (NAFLD).
In this blog, we shall try to understand how NAFLD develops, it’s clinical significance and the dietary treatment for the same. Fatty liver develops due to an imbalance between the deposition and removal of fat from the liver. In those who are non-alcoholics, this could be related to other conditions such as – obesity, dyslipidemia (impaired lipid profile), insulin resistance and diabetes. All these three conditions can potentially increase (i) the production of fat in the liver and (ii) the breakdown of the stored fat (from the adipose tissue). Both these events increase the levels of free fatty acids (FFAs) in the liver. This can cause increased deposition of FFAs in the liver causing fatty liver or NAFLD.
Obesity, dyslipidemia, insulin resistance and diabetes are all lifestyle disorders. The common risk factors associated with these disorders are –
- Increased caloric intake – Carbohydrates, proteins and fats are our main sources of calories. Of these, excessive consumption of carbohydrates and fats increases the risk of NAFLD. Eating too much of carbohydrates particularly, simple carbohydrates such as sugars, jaggery, honey, refined cereals and products made using these foods can cause increased fat accumulation in the liver. In the body, carbohydrates are broken down to simple forms like glucose. Glucose can be converted to energy for the cells. However, if the cells have sufficient energy, some glucose is stored in the liver as glycogen. If our body still has surplus glucose then, it is converted and stored as fat.
Habitual consumption of high fat diet rises the risk of NAFLD. Excess amounts of fat particularly saturated fatty acids (SFA) which is present in butter, margarine, hydrogenated fat (vanaspati, dalda), mayonnaise, cheese, cottage cheese (paneer), khoa, palm oil, organ meat and egg – increases fat deposition in the liver.
- Fructose – Fructose is a type of simple carbohydrate. Fruits naturally contain fructose. However, in the modern day, the main source of fructose is high fructose corn syrup (HFCS) present in carbonated/ non-carbonated sweetened beverages and processed foods. Research suggests that consumption of HFCS-containing foods is closely linked to obesity, increased waist circumference, insulin resistance, diabetes, cardiometabolic diseases and NAFLD.
- Sedentary lifestyle – Lack of physical activity promotes obesity and accumulation of liver fat. Individuals with a ‘pot belly’ or high waist circumference have a much higher risk of NAFLD.
- Genetics – NAFLD is also seen in individuals who are lean. These individuals appear to be genetically prone to accumulate more fat in their liver.
How would I know if I have fatty liver?
An individual with NAFLD may have no symptoms at all. Hence, it is usually discovered when medical examination is carried out for some other reason. Tests that can be indicative of NAFLD –
- Blood test – Liver function test – level of liver enzymes (SGOT, SGPT or AST, ALT)
- Ultrasound, CT, MRI
- If above tests are inconclusive, liver biopsy may be done
So, what if I have fatty liver?
People with NAFLD lack the seriousness of the issue. This is mainly because the condition is not accompanied with symptoms. However, untreated NAFLD may in the near future precipitate in to more serious liver conditions such as cirrhosis (fibrotic changes of the liver tissue), chronic liver disease, end-stage liver disease (poor functioning of the liver) and liver cancer.
How can NAFLD be prevented and/or treated with diet?
- The most effective way to reduce the fat accumulation in the liver is – weight loss particularly the fat around your belly. Research suggests that even a 5% decrease in the weight reduces the liver fat by 25%. To reduce your weight, cut down the intake of simple carbohydrates and fat.
- A major contributor to the simple carbohydrates are – HFCS-containing foods and beverages. So, it is best to avoid HFCS. At the same time, consuming fruits (also contain fructose) would be beneficial owing to the healthy components such vitamins and antioxidants present in them.
- Cut down on the amount of fats and oils consumed. Avoid fried foods and processed foods with high fat.
- Use rice bran or groundnut oil for cooking. For salads or light cooking, olive oil can also be used.
- Consume fish 2 – 3 times/week. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in omega-3 fatty acids.
- Use steaming, boiling, pressure cooking, roasting, grilling as the preferred methods of cooking.
- Physical activity along with reducing the caloric intake is the key to weight loss. Involve yourself in 30 to 40 minutes of exercise on at least 5 days a week.