Fatty Liver - Causes

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What causes nonalcoholic fatty liver disease?

The cause of NAFLD is complex and not completely understood. The most important factors appear to be the presence of obesity and diabetes. It used to be thought that obesity was nothing more than the simple accumulation of fat in the body. Fat tissues were thought to be inert, that is, they served as simply storage sites for fat and had little activity or interactions with other tissues. We now know that fat tissue is very active metabolically and has interactions and effects on tissues throughout the body.

When large amounts of fat are present as they are in obesity, the fat becomes metabolically active (actually inflamed) and gives rise to the production of many hormones and proteins that are released into the blood and have effects on cells throughout the body. One of the many effects of these hormones and proteins is to promote insulin resistance in cells.

Insulin resistance is a state in which the cells of the body do not respond adequately to insulin, a hormone produced by the pancreas. Insulin is important because it is a major promoter of glucose (sugar) uptake from the blood by cells. At first, the pancreas compensates for the insensitivity to insulin by making and releasing more insulin, but eventually it can no longer produce sufficient quantities of insulin and, in fact, may begin to produce decreasing amounts. At this point, not enough sugar enters cells, and it begins to accumulate in the blood, a state known as diabetes. Although sugar in the blood is present in large amounts, the insensitivity to insulin prevents the cells from receiving enough sugar. Since sugar is an important source of energy for cells and allows them to carry out their specialized functions, the lack of sugar begins to alter the way in which the cells function.

In addition to releasing hormones and proteins, the fat cells also begin to release some of the fat that is being stored in them in the form of fatty acids. As a result, there is an increase in the blood levels of fatty acids. This is important because large amounts of certain types of fatty acids are toxic to cells.

The release of hormones, proteins, and fatty acids from fat cells affects cells throughout the body in different ways. Liver cells, like many other cells in the body, become insulin resistant, and their metabolic processes, including their handling of fat, become altered. The liver cells increase their uptake of fatty acids from the blood where fatty acids are in abundance. Within the liver cells, the fatty acids are changed into storage fat, and the fat accumulates. At the same time, the ability of the liver to dispose of or export the accumulated fat is reduced. In addition, the liver itself continues to produce fat and to receive fat from the diet. The result is that fat accumulates to an even greater extent.

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See what others are saying

Comment from: SM, 35-44 Female (Patient) Published: March 26

About a year and a half ago I was having severe pain in my upper right side. It wasn't very often but when it happened, it would wake me from my sleep. I went to the doctor and they did an ultrasound thinking maybe it was a cyst. When the results came in, it showed that I had fatty liver. I was then sent to a specialist where I was diagnosed with NASH (nonalcoholic steatohepatitis). I have metabolic syndrome, which includes high blood pressure, high cholesterol and elevated blood sugar. I am overweight and have been my entire life. My doctor said for me to lose weight and exercise. I am on pain medication that I take every day, along with blood pressure medications and cholesterol medications. My pain episodes seem to be getting worse and more frequent even with the medicine. I am on a 1200 calorie diet and I have lost 38lbs. Last night I had an episode of severe pain and vomiting. This was the first time that the pain led to that. I go back to the doctor in a month and will have my enzymes tested along with other lab work.

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Comment from: gardo5, 55-64 Male (Patient) Published: March 07

I believe my fatty liver was caused because I drank alcohol when I had glandular fever. I had glandular fever when I was 21, it took doctors 6 weeks to diagnose whilst it was my 21st birthday and Christmas, I drank too much. I was told I was lucky, if the germ migrated 3 or 4 more inches I would have died. Since then I suffer same ailments, I had 6 biopsies, all say fatty liver or NASH (nonalcoholic steatohepatitis) but not yet cirrhosis. For 30 years I am one short step to cirrhosis and shortening of life. Yes, I've also been tested for iron overload and copper overload.

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