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home : columns : ask the doctors June 25, 2018

5/15/2018 8:03:00 AM
Fatty liver disease distressingly common in the united states

Dear Doctor: Can you talk about overweight kids and fatty liver disease? I thought this was something that only happens to alcoholics.

Dear Reader: While excessive alcohol consumption is certainly one path to a diagnosis of fatty liver disease, the condition can affect drinkers and non-drinkers alike -- raising the risk of heart disease and potentially causing subsequent problems that can lead to liver cancer. New research suggests that children who are overweight as toddlers may go on to develop the metabolic markers of fatty liver disease several years later.

Fatty liver disease is pretty much what it sounds like -- a damaging buildup of fat in the tissues of the liver. One path to that buildup is through the heavy use of alcohol, but what we're talking about here is non-alcoholic fatty liver disease, or NAFLD. This occurs when factors other than alcohol cause fat to accumulate in the liver. The presence of the fat triggers an inflammatory response that, over time, leads to liver damage.

The condition is most common among individuals who are obese or overweight, have diabetes or pre-diabetes, have high blood levels of cholesterol or triglycerides, and have high blood pressure. It's associated with metabolic syndrome, and also with certain cancer drugs, corticosteroids and hepatitis C. Research suggests there may be a genetic component as well. And although NAFLD is most common among individuals in their 40s and 50s, emerging data shows that children can be affected.

The liver, which is the largest internal organ, has a daunting to-do list. It converts food into fuel, stores that fuel and makes it available as needed, clears toxins from the blood and renders them harmless, makes proteins that help blood to clot, breaks down fats, helps manage blood sugar levels, and stores and releases various minerals and vitamins. And that's just scratching the surface. Bottom line, the liver's numerous metabolic functions mean that for you to stay healthy, your liver needs to be healthy as well.

In fatty liver disease, the presence of fat causes inflammation, which can lead to scarring and damage to the complex structures of the liver that can be irreversible. At its most extreme, NAFLD can lead to cirrhosis of the liver and even death. It's estimated that 80 million people in the United States -- that's one-quarter of the U.S. population -- have some degree of fatty liver disease. Close to 60 percent of them are men.

While NAFLD has no obvious symptoms, abdominal pain, chronic fatigue, nausea, loss of appetite and elevated liver enzymes may be indicators of the condition in individuals who exhibit the appropriate risk factors. Although at this time there are no specific treatments for the condition, lifestyle changes can have a beneficial effect.

Reaching and maintaining a healthy weight is considered the leading preventative. Several studies have shown a direct correlation between increased sugar consumption and certain metabolic changes that stress the liver. Soft drinks in particular have been shown to increase the markers of fatty liver disease. So ditch the sweets, sodas and processed foods. Focus instead on fresh fruits and vegetables, leafy greens, healthful fats and lean proteins. Your liver -- and your whole body -- will thank you.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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