Fatty liver disease : pathophysiology & assessment

In the case of continuous accumulation of lipid in the liver, fatty liver disease (FLD) will occur. FLD is a broad spectrum starting with only fat accumulation (steatosis), which can cause damage and inflammation (steatohepatitis). Steatohepatitis can cause cirrhosis and/or tumours. FLD is present in 25% to 40% of Western adults. In a large population study we found that FLD is strongly associated with markers of cardiovascular disease (CVD). Our literature review revealed that the fatty liver overproduces many markers of CVD, e.g. lipids, glucose, inflammatory cytokines, coagulation factors (production decreases in the case of cirrhosis), and factors increasing blood pressure. Through weight loss, both FLD and markers of CVD improve. Additionally, promising pharmacological treatments exist. Based on our study and the literature, we propose three groups of risk factors regarding pathogenesis of FLD: 1] risk factors for liver fat (e.g. calorie intake, exercise), 2] risk factors for inhibited hepatic metabolism (e.g. alcohol, certain medication), and 3] risk factors for hepatic inflammation (e.g. hepatitis, Crohn’s disease). Imaging modalities for assessment of FLD include magnetic resonance spectroscopy and imaging, computed tomography, and ultrasonography. Ultrasonography is usually used in a qualitative fashion, but we have developed and validated a quantitative method. Given the risks, accessibility, and treatability, we conclude to screen for FLD, by ultrasonography