Case Study: Reversing Liver damage from fatty liver
Obesity has emerged as a potential global public health threat, and its prevalence has been increasing since the beginning of the 21st century. As of 2016, more than 2 billion adults, representing 44 percent of the global adult population, were overweight or obese, with over 70 percent of them residing in low-income or middle-income countries (LMICs).
This indicates that obesity is not limited to high-income countries or urban settings but is also prevalent in LMICs, where undernutrition is persistent, posing a threat of double burden of malnutrition.
Obesity leads to several health problems. Most of these problems stem from insulin resistance in the body. One of the conditions is fatty liver progressing to Non-alcoholic steatohepatitis (NASH) and cirrhosis. This spectrum of liver disease is also called Non-alcoholic fatty liver disease or (NAFLD). Timely identification and management can lead to complete improvement and fatty liver reversal in some patients.
We will be discussing a case highlighting the same.
- Presenting Complaint: Mr. Singh, 45/Male, proposed to his general physician with complaints of fatigue, mild abdominal discomfort, and an unexplained weight gain of approximately 10 pounds over the last few months. He worked in an office and mostly sat at his job. He had no significant past medical history, was a non-smoker, and occasional alcohol consumption (1-2 drinks per week). There was no known family history of liver disease.
- Physical Examination:Upon examination, the patient appeared overweight, with a BMI of 30. His blood pressure was within the normal range, and there was no evidence of jaundice. Abdominal examination revealed mild tenderness in the right upper quadrant.
Diagnostic Tests
- Blood Tests:
Liver function tests revealed alanine aminotransferase (ALT) was 100 (normal range <30) and elevated aspartate aminotransferase (AST) of 50 (normal range <30)
Normal levels of total bilirubin and alkaline phosphatase.
Elevated levels of serum triglycerides (281mg/dL) and cholesterol (295mg/dL).
Fasting sugar was 110(normal up to 100mg/dL)
Tests for Hepatitis B and C were negative. - Imaging:
Abdominal ultrasound demonstrated increased echogenicity in the liver, indicative of fatty infiltration.
Diagnosis: Based on the clinical presentation and diagnostic tests, Mr. Singh was diagnosed with non-alcoholic fatty liver disease (NAFLD). His elevated liver enzymes and imaging findings confirmed the presence of excess fat accumulation in his liver without a history of significant alcohol consumption. His abnormal cholesterol profile and elevated fasting sugar indicated the presence of insulin resistance.
Treatment and Management
- Lifestyle Modifications:
To achieve gradual weight loss, Mr. Singh was advised to adopt a healthier lifestyle, including a balanced diet with reduced calorie intake.
Regular exercise, aiming for at least 30 minutes of moderate-intensity activity five times weekly, was recommended.
Alcohol consumption was limited to a minimum or avoided altogether. - Medication:
As his cholesterol profile showed elevated triglycerides and cholesterol, his physician prescribed medication. - Regular Follow-Up:
Mr. Singh was scheduled for follow-up appointments to monitor his progress and assess any improvements in liver function.
Outcome: Mr. Singh diligently adhered to the recommended lifestyle changes over several months. His weight gradually decreased, and his liver function tests improved. Repeat tests showed ALT was 35, AST normalized, fasting sugar was 98, Triglycerides were 180, and cholesterol was 200. A follow-up ultrasound showed a reduction in liver fat infiltration. His energy levels improved, and his abdominal discomfort resolved.
Conclusion:
This case study highlights the importance of early detection and management of non-alcoholic fatty liver disease (NAFLD). Lifestyle modifications, including dietary changes, weight loss, and regular exercise, are crucial to NAFLD management. Addressing associated risk factors such as insulin resistance leading to abnormal cholesterol profile and elevated fasting sugar can further enhance the patient’s overall health and liver function. Regular monitoring and follow-up are essential to assess progress and prevent liver disease progression.
