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Hepatic Steatosis: Understanding Fatty Liver Disease

Hepatic steatosis, sometimes called “foie gras disease,” has become a significant public health issue.Its progression reflects changes in consumption habits over recent decades. It’s a disease of our time,where increased sugar intake and alcohol consumption play key roles.

Hepatic steatosis affects approximately 25% of the population in Europe, and likely a similar percentage in Belgium, though precise figures remain estimates. This abnormal accumulation of fat in the liver, known as steatosis, can lead to inflammation. While excessive alcohol consumption is a known cause, the liver can also be damaged by a diet high in sugar or fat. Specialists than diagnose non-alcoholic steatohepatitis, or “Nash.”

What is Hepatic Steatosis?

Hepatic steatosis, or fatty liver disease, occurs when fat builds up in the liver. A healthy liver contains a small amount of fat, but when this amount exceeds 5-10% of the liver’s weight, it becomes a problem. There are two main types:

• Alcoholic Fatty Liver Disease (AFLD): Caused by heavy alcohol consumption.
• Non-Alcoholic Fatty Liver Disease (NAFLD): Develops in people who drink little or no alcohol. NAFLD is increasingly common, notably wiht the rise in obesity and type 2 diabetes.

Why is Fat Accumulation harmful?

While a little fat in the liver is normal,excessive accumulation can lead to:

• Inflammation: Fat buildup can trigger inflammation,potentially leading to non-alcoholic steatohepatitis (NASH).
• Scarring (Fibrosis): Chronic inflammation can cause scar tissue to form in the liver.
• Cirrhosis: Severe scarring can lead to cirrhosis, a serious condition where the liver is permanently damaged and can’t function properly.
• Liver Failure: In advanced cases, cirrhosis can progress to liver failure.
• Liver Cancer: Cirrhosis increases the risk of developing liver cancer.

Causes and risk Factors

The causes of hepatic steatosis vary depending on the type:

Alcoholic Fatty Liver Disease (AFLD)

AFLD is directly linked to heavy alcohol consumption. The amount and duration of alcohol use substantially impact the risk. The liver prioritizes metabolizing alcohol, which can disrupt normal fat metabolism and lead to fat accumulation.

Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD is a more complex condition with multiple contributing factors:

• Obesity: Excess weight,particularly around the abdomen,is a major risk factor.
• Type 2 Diabetes: Insulin resistance, common in type 2 diabetes, promotes fat storage in the liver.
• High Cholesterol and Triglycerides: Abnormal lipid levels contribute to fat accumulation.
• Metabolic Syndrome: A cluster of conditions including obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels.
• Genetics: Some people may be genetically predisposed to NAFLD.
• Rapid Weight Loss: While seemingly counterintuitive, very rapid weight loss can sometimes trigger fat release and accumulation in the liver.

Symptoms

Hepatic steatosis often has no symptoms, especially in its early stages. When symptoms do appear, they can be vague and non-specific:

• Fatigue
• Abdominal discomfort or pain (usually in the upper right side)
• Enlarged liver (detectable by a doctor during a physical exam)
• Elevated liver enzymes (detected thru blood tests)