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Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss?

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Gastroenterologist
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Greetings. I am concerned about the problem of "fatty liver XXXXXXX My wife was told by her doctor that she had some fatty liver and that only weight loss could eliminate it. Is this true, and what are the causes and effects of this problem? She does not consume alcohol. Thanks.
Posted Tue, 14 Aug 2012 in Digestion and Bowels
 
 
Answered by Dr. Dinesh Kumar Singal 9 hours later
Dear XXXXXX

Thanks for contacting Healthcare Magic,

Fatty liver are of two types 1) alcoholic and 2) non-alcoholic. Since your wife does not take alcohol, so her fatty liver is of non-alcoholic origin. This is initial stage of obesity, diabetes, hyperlipidemias, hypertension, metabolic disease.

About 30% of people with fatty liver develop inflammation of liver, this is called non-alcoholic steato-hepatitis (NASH). 20% of people with XXXXXXX are prone to develop cirrhosis of liver, this is a serious condition. Some people with cirrhosis may also develop liver cancer.

If she is obese she should try to reduce her weight by controlling her diet and exercising. In addition diabetes and hyperlipidemia also need to be controlled.

Hope my answers help you.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss? 1 hour later
Thank you. In fact her blood tests show completely normal cholesterol and glucose. So how is it possible to have the fatty liver even if she needs to lose fifty pounds?
 
 
Answered by Dr. Dinesh Kumar Singal 45 minutes later
Dear XXXXXX

Thanks for contacting again.

It is nice that she does not have diabetes or hypercholesterolemia. But fatty liver can occur without these, it is also not necessary to be obese. But it is most common in people with these conditions. Sometimes fatty liver may predate development of clinical diabetes, as fatty liver suggests there is underlying insulin resistance. Hence even losing weight helps because that improves insulin resistance.

Hope this clears your confusion.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss? 25 minutes later
What would be the circumstances where someone had no other related problems but had fatty liver? Is it possible for it not to worsen or improve over a person's life? And if so, why?
 
 
Answered by Dr. Dinesh Kumar Singal 3 hours later
Dear XXXXXX

It will help to know weight and height of your wife, so that we can calculate her BMI (body mass index). A BMI of more than 25 will make her prone to develop fatty liver. Insulin resistance can be there without clinical diabetes as I have already mentioned. In fact insulin resistance is present in 95% cases of fatty liver, especially who develop XXXXXXX

Certain drugs like amiodarone, methotrexate, diltiazem, glucocorticoids, tamoxifen etc. can also cause fatty liver without having diabetes. Rapid weight loss, malnutrition, bacterial overgrowth like conditions can also cause fatty liver.

It is possible that fatty liver may not worsen or may even improve over a period of time. As I have already told 30 % of people with fatty liver progress to XXXXXXX There are lot of theories regarding who will develop XXXXXXX but these are still not very clear.

Hope my reply helps you.

Best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss? 44 minutes later
If some people can have insulin resistance while showing normal blood test numbers including the Hemoglobin A1C, then how could it be detected?
My wife is about five foot two inches and weighs 180 pounds but would like weigh 125. She takes NSAIDs for arthritis pain and some supplements such as Omega 3 fish oil.
 
 
Answered by Dr. Dinesh Kumar Singal 25 hours later
Dear XXXXXX

Your wife's BMI (body mass index) is 32.9, this places her in obese category. This is the most common cause for fatty liver. Ideally her BMI should be less than 25.

HbA1C can be normal in condition of insulin resistance. Insulin resistance is calculated by two tests namely 1) HOMA-IR test and 2) clamp test. HOMA-IR is calculated by using fasting insulin and glucose levels and putting these values in a equation. Clamp test is a slightly complicated test.

With best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss? 5 minutes later
Does the fact of normal A1C numbers means that these tests are useless for determining who is insulin resistant even if they show numbers indicating insulin resistance? In other words if a person's A1C is 56% with Glucose of 97 he think he's OK, but actually he cannot know that unless he does the HOMA-IR test and clamp test? And then many people and their doctors who think they are normal are not because they have not been advised to do the HOMA0-IR and clamp test?
So what is a person to do then? Do we assume that everyone who is obese is insulin resistant if they have not taken those two tests to prove otherwise?
 
 
Answered by Dr. Dinesh Kumar Singal 20 hours later
Dear XXXXXX

Thanks for your queries.

HbA1C has nothing to do with insulin resistance. It is a measure of sugar control in diabetics. This is done to assess average sugar control during last 3 months in people who are know to have diabetes. Normal HbA1C levels range from 3.5 - 5.5 %.

HOMA-IR and Clamp tests are not done routinely in clinical practice. Usually these are needed for research purposes. Obese people are more prone to get insulin resistance as compared to non-obese.

With best wishes,

Dr Dinesh Singal
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with fatty liver. What are the cause and effects of this problem? Will it be cured by weight loss? 1 hour later
Does this simply mean that even a person with normal glucose numbers has to be concerned to get the A1C number closer to 5.5%, and even that might not be the end of the story since there is still the issue of the clamp test and the HOMA-IR as well even if the A1C improved?
 
 
Answered by Dr. Dinesh Kumar Singal 14 hours later
Dear XXXXXX

No, a person with normal glucose does not need HbA1C. This is usually needed only in case of diabetics.

Dr Dinesh Singal
Above answer was peer-reviewed by
 
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