Steatosis

Introduction

The liver is the main organ involved in fat metabolism. Damage to the hepatocytes disrupts this process and leads to steatosis.

Steatosis is an excessive accumulation of fats in the liver, and may be either alcoholic or non-alcoholic.

  • The relationship between the quantity of alcohol consumed and the development of alcoholic liver disease (ALD) is nonlinear, but an intake of about > 30-50 g/day (> 2 drinks/day in females and > 3 drinks/day in males) for at least 1 year is considered to place an individual at risk for ALD.
  • Non-alcoholic fatty liver disease (NAFLD) ranges from the more benign condition of non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), which is associated with lobular inflammation and apoptosis that can lead to fibrosis and cirrhosis.



Clinical Features

Steatosis is associated with abnormal liver function tests and can be asymptomatic.

A patient presenting with steatosis generally shows fatigue, nausea, vomiting, hypoglycemia and confusion. Jaundice is present in severe cases.



Management

There is NO specific treatments for fatty liver diseases. Instead, management focus on helping patients manage contributing factors.

Counsel patients to neither drink nor smoke.

  • Strict alcohol abstinence is critical in preventing disease progression and reducing mortality.
  • Concomitant smoking and alcohol usage reported to have synergistic effect on promoting cirrhosis, cancer and cardiovascular disease.

Address other potential exacerbating factors such as

Ensure proper nutrition including liberal multivitamins and minerals.

  • Recommended to have at least 35-40 kcal/kg and 1.2-1.5 g/kg protein per body weight.
  • Addressing thiamine deficiency to avoid Wernicke-Korsakoff syndrome and Wernicke encephalopathy.



Complementary Therapies

Essential phospholipids (EPL) have anti-inflammatory and antioxidant properties and are used as supportive treatment in alcoholic and non-alcoholic fatty liver disease.

Milk thistle (Silymarin or Silybum marianum) is a free radical scavenger that provides hepatoprotective to patients with alcoholic and non-alcoholic liver disease.

Antioxidants (e.g. S-adenosylmethionine and vitamin E) decrease oxidative stress and protects the liver from injury due to inflammation.

A 2021 study involving nearly 500,000 people finds that drinking coffee significantly lowers the risk of developing liver disease.

  • The health benefit applies to all kinds of coffee, including caffeinated, decaffeinated, ground, and instant coffee.
  • The maximal protective effect was seen at 3-4 cups each day.



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