Nonalcoholic Fatty Liver Disease is a disorder of the liver that is commonly associated with other medical conditions like insulin resistance, metabolic syndrome, and type 2 diabetes. The inflammatory version of this disorder is called NASH (Nonalcoholic Steatohepatitis). NASH is dangerous due to the progressive development of liver fibrosis that can result.

If left untreated, more than 20% of NASH patients can develop cirrhosis during their lifetime and have an increased risk of liver (hepatocellular) cancer.

Any idea of what the second-leading indication for liver transplant is, in the US?

NASH.

The most common denominator for both Nonalcoholic Fatty Liver Disease and NASH is having a BMI (body mass index) over 30 with a diagnosis of obesity.

The good news?? (Yes, please!!)

Weight loss through lifestyle intervention and bariatric surgery can help reverse NASH and improve fatty liver disease!

You may be wondering; “How would I know if I have a fatty liver or not?”
You likely wouldn’t know on your own. The majority of patients with fatty liver disease/ NASH do not have symptoms due to the silent nature of the disease. The identification of this diagnosis usually gets picked up when imaging is actually being done for other medical reasons.

Liver blood tests may show elevated enzymes, but these lab tests are not very accurate at correlating a conclusive diagnosis to a liver disorder, the severity of inflammation, or liver fibrosis.

Ultrasound is usually the first form of imaging that can be done to evaluate the amount of fat found in the liver. MRI is the most sensitive (when compared to ultrasound and CT imaging), but is more cost and tolerance prohibitive.

Ultimately, liver biopsy is the “gold standard” assessment method to differentiate fatty liver, NASH, and fibrosis of the liver (among other conditions). This is typically done at the time of your bariatric surgery while you are completely asleep under anesthesia.

It is important to speak with your surgeon about whether a “wedge liver biopsy” is relevant to your surgery or not. At the end of the day, the treatment approach remains the same: lifestyle modifications and continued weight loss.