Some say fatty liver is the mildest liver disease.

But serious liver diseases, cirrhosis, liver cancer, and chronic hepatitis all start from fatty liver disease.

Fatty liver disease is common, about 27% of the population suffer from fatty liver disease, but only 5% progress to cirrhosis and cancer. Professor Dr. Alexandru Oproiu explained what this disease means.

Fatty liver can be characterized as a deposition of fat in the liver cells, especially triglycerides.

Loaded with fat, liver cells no longer perform their functions.

This is the first phase of the disease: hepatic steatosis. It progresses to inflammation and steatohepatitis. Neglected, it leads to fibrosis, that hardening of the liver tissue, a kind of scarring that hinders liver function and blocks the passage of blood through the liver.

Action needs to be taken, primarily by changing lifestyle. Obesity needs to be tackled, less animal fats, no more concentrated and floury sweets and of course exercise, at least a half-hour walk in the evening.

Body mass index should not jump above 28-30, and waist circumference in men should be under 102 centimeters and in women under 88.

If the weight loss is not significant, weight loss and appetite-reducing drugs can also be used, but this is not preferable given the side effects of these drugs. It is not a case of losing weight on the spur of the moment; it is advisable to lose 500 grams a week, i.e. two kilos a month.

You have to be aware of that metabolic syndrome X, the quartet of death. Reduce obesity, treat diabetes conscientiously with diet and medication, and take a daily combination of anti-hypertension drugs. To lower cholesterol and triglycerides in the blood, statin treatment is necessary.

Fatty liver is a cunning disease, it does not give clear signals and only regular check-ups can discover this disease.

Most patients with steatosis show no symptoms, but some of them may report fatigue, weakness or right subcostal pain. Many present for altered liver function tests discovered by chance at routine examinations.

Advanced liver disease is characterized by severe symptoms such as jaundice, edema, or ascites (fluid in the peritoneal cavity). Physical examination may also reveal hepatomegaly (enlargement of the liver), and in more advanced cases (cirrhosis), splenomegaly (enlargement of the spleen).

Of course, alcohol drinkers who drink more alcohol than the liver can metabolize are most at risk of hepatic steatosis. Those with fatty alcoholic livers must switch to eliminating alcohol altogether. Those who are unable to get rid of obesity, especially when it is severe obesity, can turn to bariatric surgery.

Radio imaging and laboratory investigations

Blood tests: liver function tests, especially liver enzymes, can help the doctor make a diagnosis. In steatotic hepatitis, ALT and AST liver enzymes may be elevated, and GGT is especially increased in alcohol-associated liver disease.

In non-alcoholic steatosis, elevations in serum lipids (cholesterol, triglycerides) or blood glucose (serum glucose) are often seen.

Imaging procedures. Abdominal ultrasound, as well as CT and MRI scans, may reveal hepatic steatosis.

Assessment of liver fibrosis.

If more advanced liver disease is suspected, tests may be needed to determine the extent to which the liver is affected by fibrosis (a form of scarring of liver tissue that can occur over time as a result of inflammation of liver cells).

Fibrosis can be detected both by an invasive procedure (liver biopsy, i.e. taking a small sample of liver tissue using a special needle puncture) and by non-invasive tests (Fibroscan or FibroMax).