ARE FATTY LIVERS AS INNOCENT AS IT SEEMS?

When I was in Medical School, we were taught that fatty liver is a minor insult on the liver, probably from alcoholism and that if we stop drinking, they all recover.
Lately we have been seeing a spate of fatty livers discovered on ultrasound of the liver. What is the significance, if any?


Well two interesting papers were presented at the recent meeting of the Liver Congress, in London ( last weekend ). One paper was from Japan, and the other from France.
The Japanese paper was presented by Dr H Yamazaki from the Teine Keijin Hospital, Sapporo, Japan. He and colleagues followed up 3074 patients with non-alcoholic fatty livers over 10 years ( a mean of 11.3 years ). They all have an ultrasound of the liver, and had their coronary risk factors looked at. They found that of the 3074 patients, 24% had non-alcoholic fatty liver and of these 16.1% were diabetic. They followed these patients up for 10 years and repeated their liver scans. They found that there was improvement in 110 patients. And that these patients with fatty liver resolution also had improvement in T2DM status. Those who had no improvement in fatty liver scans at 10 years, also had no improvement in T2DM status.
It looks like fatty liver may be associated with the onset of T2DM and that improvement in Liver status may improve their T2 DM status. In non-alcoholics in Japan ( quite a rarity ).

The other study is the French study. This French study was led by Dr Raluca Pais of University Pierre at Marie Curie and Hospital de la Pitrie-Salpetrire, Paris. They used ultrasound scan of liver and carotid ultrasound to measure carotid intima thickness. They scan 5671 patients aged 20-75 years, who were non alcoholics. All these patients had two or more cardiovascular risk factors. They found that the carotid intima was thicker and there were more carotid plaques in the 1871 patients who had fatty liver in liver ultrasound, when compared to the rest who did not have fatty live. When these 1871 patients were followed up for 8 years and the carotid ultrasound was repeated, there was increase in carotid intimal thickness of 34%. They concluded that fatty liver may be a risk factor for atherosclerosis.

I suppose if you think about it, maybe fatty liver in non-alcoholics, may be an indicator of metabolic syndrome and visceral obesity, and should be consider a cardiovascular risk factor. We do not yet know all the correlations but fatty liver may not be as innocent as it was previously thought.