Byline: Dr. Gary S. Sy

NON-alcoholic fatty liver disease describes a range of conditions involving the liver that affect people who drink little or no alcohol.

The mildest type is simple fatty liver an accumulation of fat within your liver that usually causes no liver damage.

A potentially more serious type, non-alcoholic, is associated with liver-damaging inflammation and, sometimes, the formation of fibrous tissue. In some cases, this can progress either to cirrhosis, which can produce progressive, irreversible liver scarring, or to liver cancer.

Non-alcoholic fatty liver disease affects all age groups, including children. Most often, it's diagnosed in middle-aged people who are overweight or obese, and who may also have diabetes and elevated cholesterol and triglyceride levels.

Signs and symptoms

You may not have signs and symptoms of simple fatty liver or non-alcoholic. When symptoms do occur, they are usually vague and non-specific and may include:

* Fatigue

* Malaise

A dull ache in your upper right abdomen, a possible sign of an enlarged liver

At a more advanced stage, such as cirrhosis, non-alcoholic fatty liver disease may cause:

* Lack of appetite

* Weight loss

* Nausea

* Small, red spider veins under your skin or easy brushing

* Weakness

* Fatigue

* Yellowing of your skin and eyes and dark, cola-colored urine

* Bleeding from engorged veins in your esophagus or intestines

* Loss of interest in sex

* Fluid in your abdominal cavity (ascites)

* Itching on your hands and feet and eventually on your entire body

* Swelling of your legs and feet from retained fluid (edoma)

* Mental confusion, such as fortgetfulness or trouble concentrating (encephalopathy)

* Liver failure

Causes

* Obesity, particularly around the waist (abdomenal obesity)

* High blood pressure (hypertension)

* One or more abnormal cholesterol levels - high levels of triglycerides, a type of bloodfat, or low levels of high-density lipoprotein (HDL) cholesterol

* Resistance to insulin, a hormone that helps to regulate the amount of sugar in your blood

Risk factors

* Overweight and obesity. Your risk increases with every pound of excess weight. More than 70 percent of people with non-alcoholic are obese. Overweight is defined as having a body mass index between 25 and 29.9; obesity is defined as having a body mass index of 30 or higher.

* Diabetes. When your body becomes resistant to the effects of insulin or your pancreas doesn't produce enough insulin to maintain a normal blood sugar (glucose) level, this can damage many organs in your body, including your liver. Hyperlipidemia. High cholesterol levels and elevated triglycerides are common.

* Other risk factors include:

* Abdominal surgery. Operations to remove large sections of the small intestine (small bowel resection), treat obesity (gastric bypass) or bypass parts of the small intestine (duodenal bypass) often lead to rapid weight loss, which may increase your risk of non-alcoholic fatty liver disease.

* Medications. These include oral corticosteroids, synthetic estrogen or menopause, amiodarone of heart arrhythmias, tamoxifion for breast cancer and methotrexate Rheumatrex Trexall), an immune-suppressing medication for rheumatoid arthritis.

* Other conditions. These include Wilson's disease a hereditary condition that affects copper levels; Weber-Christian disease, which affects nutrient absorption; and abetalipoproteinemia, a rare congenital disorder that affects the ability to digest fat. Inherited metabolic disorders that increase the risk of cirrhosis include galactossmia a rare disorder that affects the way the body metabolizes milk sugar (lactose), and glycogen storage diseases, which prevent glycogen, the stored form of glucose, from being formed or released when your body requires it.

Treatment

The best treatment for you depends on this underlying cause of your non-alcoholic fatty liver disease. Preferred treatments include:

* Weight loss and exercise. If your body mass index is above 25, a diet and exercise program may reduce the amount of accumulated fat in your liver. The most effective diet is rich in fiber and low in calories and saturated fat, with total fat accounting for no more than 30 percent of total calories. But go slowly. Aim to lose 10 percent of your body weight over six months, because rapid weight loss may lead to worsening of liver disease. Even if you aren't overweight or obese, a healthy diet and daily physical activity may reduce inflammation, lower elevated levels of liver enzymes and decrease insulin resistance.

* Diabetes control. Strict management of diabetes with diet, medications or insulin lowers blood sugar, which may prevent further liver damage. It may also reduce the amount of accumulated fat in your liver.

* Cholesterol control. Controlling elevated levels of cholesterol and triglycerides with diet, exercise and cholesterol-lowering medications may help stabilize or reverse non-alcoholic fatty liver disease.

* Avoidance of toxic substances. If you have non-alcoholic liver disease - especially non-alcoholic steatohepatitis (NASH) - don't drink alcohol. Also avoid medications and other substances that can cause liver damage. Talk to your doctor about which drugs to avoid.

Prevention

Your best defense against non-alcoholic fatty liver disease is to maintain a healthy weight and normal cholesterol and blood sugar levels. This strategy, along with avoiding excess alcohol and other substances that could be harmful to your liver, can help reduce your risk of liver disease.

Dr. Gary S. Sy, M.D. is the Medical Director of Life Extension Medical Center located at The Garden Plaza Hotel (formerly Swiss Inn Hotel) 1370 General Luna St., Paco, Manila. He is a Diplomate in Gerontology and Geriatrics, advocate Diet-Nutritional Therapy, and conducts free seminar every Friday about age-related health problems. For more details, please call tel. nos. 400-42-05 or 522-48-35 local 315.

E-mail address: lifeextension_drgarysy@yahoo.com. Please tune in at DZRH 666 kHz "Operation Tulong" every Wednesday and Friday at 10 p.m.-11 p.m. and DZMM 630 kHz "Gabay sa Kalusugan'' awarded as "2005 CMMA as Best Educational Radio Program Program,'' every Sunday at 10 a.m.-11:00 a.m.