Hepatic steatosis, commonly known as fatty liver, is a diagnosis that is advancing at a rapid pace around the world. Between 1990 and 2019, the global prevalence of the non-alcoholic condition rose from 25% to about 38%, according to a survey published in the journal Hepatology in 2023.
This progress worries researchers and puts pressure on health systems, especially because of the difficulty of diagnosis, as the condition develops silently most of the time. However, some markers allow us to identify people at high risk as well as those who already have an advanced stage of the condition.
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Understanding the relationship between protein and fat accumulation in the liver
Endocrinologist Natalia Cinquini, medical advisor at Sabin Diagnóstico e Saúde, highlights that a sedentary lifestyle and inadequate eating patterns, a preference for processed and fatty foods, are a warning sign. He says: “Many people think that only those who drink a lot are at risk of developing fatty liver, but this is not true. Lifestyle affects the liver in people of any age.”
Hepatic steatosis is recognized when fat accumulation exceeds 5% of the liver composition. Without changes in habits that reverse the condition, progression can lead to inflammation, fibrosis, cirrhosis, and, in extreme cases, liver cancer.
“I think 70% of people with steatosis do not know they are sick. Having inflammation for a long time can become chronic and cause scarring of the liver and other problems,” warns general practitioner Marcos Pontes, of Clínica Evoluccy, in Brasilia.
Does fatty liver have symptoms?
There are symptoms that appear as the disease progresses, but they do not appear until very advanced stages. The initial stage usually remains silent, without specific signs that allow immediate suspicion.
When symptoms do appear, they include persistent fatigue, loss of appetite, bloating, increased abdominal size, and discomfort in the right upper quadrant of the abdomen, which are signs of liver dysfunction.
Without proper treatment, in advanced cases, jaundice, ascites, dark urine, and light stool may appear, all of which are signs of possible organ failure. About 30% of patients with steatosis develop inflammation and fibrosis, and about 15% develop cirrhosis.
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Fatty degeneration of the liver is popularly known as fatty liver
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Fatty liver disease affects 30% of the world’s population
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Changes in liver function can cause sleep disturbances such as insomnia, daytime sleepiness, and irregular rest cycles.
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Initially, the manifestations are usually non-specific, such as fatigue, weakness, loss of appetite, nausea, and a feeling of flatulence or discomfort in the right side of the abdomen.
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How does steatosis become dangerous?
In more advanced cases, known as MASH, fat leads to persistent inflammation in the liver, generating progressive scarring (fibrosis). Scar tissue loses its function to the point of threatening the functioning of the entire organ.
Hepatologist Jean Taffarel, of Kajuru University Hospital, warns that nearly 90% of MASH diagnoses occur late. Delay limits treatment options and increases the risk of complications.
“It is normal for the liver to be free of fibrosis. When fats start attacking the cells, they are replaced by scars. This cascade of injuries can develop into cirrhosis and even lead to the need for an organ transplant,” he explains.
Prevention and management in focus
Therefore, prevention becomes an essential element in treating the disease. Regular evaluation, weight control, and a balanced diet form the basis for protecting the liver and the body as a whole.
“For a long time, it was thought that steatosis would not have serious consequences, but today we know that it can develop into cirrhosis and even liver cancer. Preventive care is essential,” says Taffarel.
Current treatment is based on lifestyle changes, as there is no specific approved medication. The strategy includes eating a balanced diet rich in fruits, vegetables and fibre, limiting ultra-processed foods, controlling weight, getting regular physical activity and limiting alcohol.
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