Some individuals can develop fatty liver. Most people who do not abuse alcohol and have fatty liver are obese. The term that has been accepted is non-alcoholic fatty liver disease (NAFLD).

Recently, there has been a movement to change the name to METABOLIC ASSOCIATED FATTY LIVER DISEASE, or MAFLD. This name change is being done to better reflect the understanding of fatty liver disease, realizing that the majority of these patients have "metabolic syndrome", the driving force behind many of the fatty liver cases.

Fatty liver is called steatosis, and fatty liver with liver inflammation is called NASH or steatohepatitis. Steatosis and steatohepatitis can be caused by alcohol and other drugs and can also occur in patients with diabetes mellitus. The factors that determine who will develop fatty liver are not known. Some mildly obese and occasional non-obese patients will develop fatty liver while some who are severely obese will not. There is a direct relationship between the metabolic syndrome and NAFLD.

Patients with fatty liver or steatohepatitis usually present to a physician with unexplained elevations in the serum aminotransferase (ALT/AST) activities. Serum alkaline phosphatase and gamma-glutamyltranspeptidase (GGTP) activities can also be elevated. The patient is usually 10% or more above his/her ideal body weight.

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The diagnosis is usually suspected after other causes of hepatitis are excluded. A careful medication and alcohol history should be taken and serological testing for hepatitis B and C should be performed. A careful family history and appropriate testing if they are suspected should exclude metabolic diseases. Serum protein electrophoresis and testing for autoantibodies should be performed if autoimmune hepatitis is suspected.

Sometimes, patients with fatty liver or steatohepatitis will have elevated serum triglyceride concentrations, however, this is not always the case. If a patient has elevations in serum aminotransferase activities for longer than six months, he/she should have a liver biopsy to make the diagnosis the fatty liver or steatohepatitis. Steatohepatitis can progress to cirrhosis. Treatment (diet and exercise) may stop this progression. Steatosis and steatohepatitis will often improve with weight loss, preferably to near the patient's ideal body weight.

Avoidance of alcohol and potentially hepatotoxic drugs may also be beneficial.
The presence of diabetes mellitus needs to be rules out. In many situations, patients are “glucose intolerant”, which can be considered a pre-diabetic state. Screening with a four-hour glucose tolerance test may be scheduled through our office.

Left untreated, fatty liver, in select cases, may progress to cirrhosos, liver cancer, and liver failure. Unfortunately, premature death is a common complication in fatty liver. In the most advanced cases, liver transplantation may be required.