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overview of fatty liver in community acquired
- 2. Introduction Liver isa critical organ in the human body responsible for an array of functions that helps support metabolism, immunity, digestion, detoxification and vitamin storage, among others functions Comprises around 2% of an adult’s body weight When the liver becomes overwhelmed with excess fat , it can lead to inflammation and scarring, impairing its function
- 3. INTRODUCTION Viral hepatitisB and C (HBV, HCV) and non- alcoholic fatty liver disease (NAFLD) are the commonest etiologies of liver-related deaths in Malaysia. Hepatocellular carcinoma and liver cirrhosis impose significant health issues worldwide due to viral hepatitis B (HBV) and C (HCV) and non-alcoholic fatty liver disease (NAFLD). In Malaysia, hepatocellular carcinoma was ranked third in cancer-caused mortality, contributing up 4 % of all new local cancer cases in 2020 with an estimated age-standardized death rate of 7.78 per 100 000 in 2018. Liver cirrhosis emerged as a top 10 leading cause of death in Malaysia in 2019
- 4. NAFLD isnow becoming the most common liver disease in Malaysia with higher prevalence of 37.4% in 2018 compared 22.7% in 2013. With Malaysia being ranked first in both adult and childhood obesity in Southeast Asia, coupled with the recent findings that 1in 2 Malaysians are overweight or obese, or with abdominal obesity, NAFLD incidence and prevalence will continue to increase.
- 5. Fatty liver disease Fatty liver disease is a condition characterised by the accumulation of excess fat in the liver. With a small amount of fat in the liver is normal, when the fat content exceeds 5-10% of the liver’s weight, the liver is considered to be fatty. Fatty liver represents a spectrum of liver disease comprising : Fat cell accumulation in the liver (steatosis) Evidence of injury to the liver cells (steatohepatitis) Scarring process in the liver (fibrosis) and finally leads to Cirrhosis (hardening) to the liver
- 7. Types of fattyliver Alcoholic fatty liver disease • Caused by excessive alcohol consumption • Can range from mild to severe and may progress to more serious liver conditions, such as alcoholic hepatitis and cirrhosis Non-alcoholic fatty liver disease • Occurs in individuals who do not consume alcohol • Further divided into two subtypes- • Non-alcoholic fatty liver (NAFL)-benign • Non-alcoholic steatohepatitis (NASH)-more severe and can lead to liver inflammation and scarring
- 9. Risk factors Obesity(BMI > 30) Diabetes mellitus or Insulin resistance High cholesterol Metabolic syndrome Individual with more than 3 diseases which are Waist circumference female >80 cm male >90 cm Diabetes mellitus Hypertension Heart disease Hypothyroidism Genetic
- 10. Hypothyroidism AND Fattyliver Thyroid hormones are essential for liver function and liver metabolism. Insufficient levels of thyroid hormones promote fatty infiltration of the liver, impairing its ability to metabolize fat, and increasing the risk of NAFLD. Overt hypothyroidism and subclinical hypothyroidism are considered independent risk factors for NAFLD Studies have shown that patients with hypothyroidism have a 2.7 fold higher risk of developing of NALFD or NASH
- 11. Hypothyroidism AND Fattyliver Hypothyroidism increases the risk of developing insulin resistance and impaired glucose metabolism, another risk factor for NAFLD. Up to 90% of hypothyroid patients have abnormal lipid values. Hypothyroidism increases the risk of impaired fat processing. Up to 90% of hypothyroid patients have abnormal serum lipids , including high cholesterol and triglyceride levels. These are all risk factors for NAFLD. Hypothyroidism increases the risk of being overweight or obese, which are risk factors for NAFLD. On average, hypothyroid patients weigh 15 to 30% more than when thyroid function is entirely normal.
- 12. In early stage,fatty liver disease often presents with no noticeable symptoms Often discovered incidentally during routine medical tests. As the disease progresses, some individuals may experience :
- 13. Diagnosis and riskassessment Diagnosing fatty liver disease involves a combination of medical history, physical examination and various tests, including Blood test LFT ( AST ALT) Infective screening- viral hepatitis B and C Fasting blood sugar Fasting lipid profile Thyroid function Imaging studies Ultrasound abdomen (basic) Fibroscan Liver biopsy May be recommended to determine the extent of liver damage and rule out other conditions
- 14. Ultrasound Is abasic imaging (non invasive ) steatotic livers look brighter than normal livers, and cirrhotic livers (advanced fibrosis) look lumpy and shrunken.
- 15. Fibroscan Is moresensitive and specific than ultrasound in detecting fatty liver in the presence of moderate or severe probability of fibrosis. Helps to diagnose and monitor the progression of diseases affecting the liver It measures liver stiffness and fatty changes in the liver.
- 16. Fibroscan vs liverbiopsy
- 17. Risk assessment Ifliver is damaged due to inflammation, liver enzymes may be higher than normal. However, LFT do not tell how much scarring (fibrosis) may be present or predict how much liver damage will develop. In some people with NAFLD, LFT may be normal Fibrosis assessment test will estimate level of liver scarring or fibrosis. These test include NAFLD fibrosis score Fibrosis- 4 (Fib-4)score Reduce the need for liver biopsy by identifying patient with non- alcoholic fatty liver disease likely or unlikely to have advanced fibrosis
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- 20. The lower thescore, the less scarring and healthier the liver
- 21. Complications Patient witha long –standing fatty liver may progress to liver cirrhosis like in any other chronic liver patients Cirrhotic patients may deteriorate with ascites, hematemesis or sudden vomiting of blood due to variceal bleeding in the esophagus and hepatic encephalopathy Also at risk of developing liver cancer or hepatoma
- 22. Patients withrisk factors for NAFLD such as those with diabetes, hypertension or dyslipidemia should have a proper follow-up because most of the patients with fatty liver do not have any prominent symptoms Early prevention would avoid development of cirrhosis and further complications.
- 23. Management No approvedmedicines ( the goal of management is to reduce of risk factors) Reduce weight ( if overweight BMI> 25 )- will reverse fatty liver, fibrosis and insulin resistance liver patients who are obese or overweight are encouraged to lose weight gradually Recommended weight loss is between 3-10% from current weight Do regular exercise Help reduce fat cells Recommended 30 -40 minutes for 3 to 4 times per week
- 24. Balance diet Reduce blood sugar Reduce the intake of high fat and high cholesterol foods Increase fibre intake such as vegetables and fruits Bariatric surgery Weight loss surgery-modifying digestive system (stomach and small intestine) Obese patient
- 26. Foods to take Whole grain—rich in fibre and helps improve digestion Fruits and vegetables- high in fibre, vitamins, minerals and antioxidants Lean proteins- chickens, fish and legumes Healthy fats- eg nuts, seeds, avocado, olive oil Coffee and Green tea- contains antioxidant to reduce liver inflammation
- 27. Foods to avoid Sugar and high-fructose corn syrup Saturated and trans fat- increase the inflammation in the liver Butter, cheese, fatty meats Found in many processed foods such as Margarine and fried foods
- 28. Alcohol Processedfood White bread and pasta High in refined carbohydrates which can lead to fatty liver disease Contains high glycemic index, leading to rapid spikes in blood sugar lever
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- 30. Medications • Glucocorticoids • Syntheticestrogens • Amiodarone (Cordarone, Pacerone) • Methotrexate (Rheumatrex, Trexall) • Tamoxifen (Nolvadex, Soltamox
- 32. MAFLD Is linkedto obesity, insulin resistance and hypertension. Can lead to liver abnormalities like steatosis, fibrosis and cirrhosis, and is associated with diabetes and cardiovascular disease.