Fatty liver disease is the most common cause of abnormal liver function tests in the world. Dr Martin Weltman discusses the causes, implications, diagnosis and treatment of non-alcoholic fatty liver disease.


Hello I’m Dr Martin Weltman, Gastroenterologist and Associate Professor of Medicine at the University of Sydney, as well as Director of Gastroenterology at Nepean Hospital. I joined the Editorial Advisory Board of the Virtual Gastro Centre one year ago, and today I would like to share with you my insights on fatty liver.

One of my major clinical and research interests is that of non-alcoholic fatty liver disease, which is the commonest liver condition in the Western world. Non-alcoholic fatty liver disease or NAFLD is the result of accumulation of excessive fatty deposits in the liver. It includes simple steatosis or excessive accumulation of fatty deposits in the liver alone, to more aggressive forms, with associated inflammation and the formation of scar tissue or fibrosis, and in some cases, this can lead to cirrhosis.

Fatty liver can be caused by excessive alcohol consumption but when we refer to the term NAFLD, which is the more common clinical condition, it is associated with the conditions of obesity, type 2 diabetes and elevated blood lipid levels. These conditions in turn exist in an environment of what we call insulin resistance. It is the high insulin levels that drive fat into the liver.

Based on American studies, up to 20% of the adult population have fatty liver disease. The condition is also increasingly being observed in children, and in part this is related to their epidemic of obesity and type 2 diabetes. Because of insulin resistance, patients with non-alcohol fatty liver disease, are at increased risk of cardiovascular complications and type 2 diabetes.

The majority of people with fatty liver disease do not have any symptoms. They usually come to medical attention after a series of abnormal liver function blood tests, and an abnormal liver ultrasound. Treatment is focused on lifestyle changes with weight loss, through healthy eating and increased physical activity. Ideally fad diets should be avoided as weight loss needs to be sustained. Alcohol consumption should be kept to a minimum.

The added benefits of the healthy lifestyle approach include the benefits to the associated diabetes and cardiovascular disease risk factors. The elevated cholesterol and triglyceride levels, may require medical therapy with lipid lowering drugs such as statins. Diabetic control should be strictly monitored. Recent studies suggest a role for drugs which enhance insulin sensitivity and these include drugs such as metformin and rosiglitazone.

Thank you for watching, and have a great day.

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