Fatty Liver: Are Prescribed Medications The Culprit?

UM Specialist Centre (UMSC) gastroenterologist and hepatologist, Associate Professor Dr Chan Wah Kheong (left) and UMSC Endocrinologist Dr Jeyakantha Ratnasingam during an interview with BERNAMA at UMSC recently. -- fotoBERNAMA (2018) COPYRIGHT RESERVED

By Salbiah Said

This is the final of a two-part article on fatty liver.

PETALING JAYA (Bernama) -- There are currently no medications for the treatment of fatty liver.

The most effective treatment for the disease is a combination of healthy diet, exercise and weight control, according to UM Specialist Centre ( UMSC ) consultant gastroenterologist and hepatologist Prof Dr Chan Wah Kheong and consultant endocrinologist  Dr Jeyakantha Ratnasingam. 

Dr Chan, however, cautioned that certain medications such as steroids, which are used to treat certain medical conditions, could contribute to fatty liver.

“A doctor will weigh the risks and benefits of prescribing a medication to the patient. If a patient requires steroids for treatment of a certain medical condition, it is important for him or her to continue with the steroids.

“The doctor will normally ensure that the patient is given the lowest possible dose to keep the disease under control. Or, he may change the steroids to some other medication that has similar effects, but do not have the side effects of steroids,” he told Bernama during an interview at  UMSC , here, recently.

He said it is important for patients to be diagnosed and treated by a certified doctor who " will weigh the benefits of a medication against its risks".

DIABETES MEDICATION DOES NOT LEAD TO FATTY LIVER

Dr Jeyakantha clarified that medications to treat diabetes mellitus do not lead to fatty liver.

"The more obese or overweight you are, the higher your risk of developing fatty liver. So it is actually the disease itself that contributes to fatty liver rather than the medications that are used to treat the disease. 

“The medications that are prescribed to treat diabetes actually bring down the sugar level and may help the patient to lose some weight, especially the newer types of medications for diabetes. That actually improves the fatty liver and not worsen the condition," he pointed out.

Dr Chan also stressed that chronic over-nutrition or overeating is the primary culprit for fatty liver, not prescribed medications.

“In the past, fatty liver was assumed to be due to alcohol (consumption), but a clinician's findings in the 1980s changed the perception. Non-drinkers were also found to have fatty liver. 

"What was common among these patients was that they were obese and had diabetes mellitus, hypertension and high cholesterol. That's how the term non-alcoholic fatty liver disease was coined," he added. 

Non-alcoholic fatty liver disease (NAFLD) is one of the types of fatty liver which occurs when fat is deposited (steatosis) in the liver due to causes other than excessive alcohol use. Non-alcoholic steatohepatitis (NASH) is the most extreme and fast progressing subtype of NAFLD.  

Soft drinks are as hazardous as alcohol to the liver, according to Dr Jeyakantha, who added that a diet high in sugar and fructose actually fuels fatty liver similar to the way alcohol does. 

Smoking, on the other hand, does not directly lead to fatty liver but it has a huge negative impact on the overall cardiovascular health of a person, who is at risk of developing stroke and heart attack, he added.

COMPLICATIONS OF CIRRHOSIS

The number of patients admitted for complications of cirrhosis due to fatty liver is on the rise, said Dr Chan, adding that the patients were often not known to have liver disease prior to that. Cirrhosis is a condition in which the liver is severely scarred.

"In the past, we often diagnose other causes of chronic liver disease in patients admitted for complications of cirrhosis, such as hepatitis B virus infection, hepatitis C virus infection or there may be a history of heavy alcohol consumption.

"These are common causes of chronic liver disease. However, more and more patients admitted for complications of cirrhosis nowadays do not have these conditions. Instead, they are obese and have diabetes mellitus, hypertension and dyslipidemia. Yes, they have fatty liver which has led to cirrhosis and its complications," he explained.

Dr Chan said fatty liver can be diagnosed easily through an ultrasound examination. Once fatty liver is detected, the doctor should assess the severity of the fatty liver. 

"Fibroscan is a non-invasive test that can be easily performed to estimate the amount of scarring in the liver. A patient will require more aggressive management if there is cirrhosis of the liver to prevent the complications of cirrhosis,” he said.

LIVER CANCER

Patients with cirrhosis are at increased risk of liver cancer and should undergo regular ultrasound examination for early detection of liver cancer. 

"When diagnosed early, liver cancer is potentially curable," Dr Chan said. "However, if there is no surveillance for patients with cirrhosis (by performing regular ultrasound), they often present with liver cancer at a much later stage whereby a cure is not possible."

According to Dr Jeyakantha, once a patient is diagnosed with fatty liver, screening for other components of the metabolic syndrome, such as diabetes mellitus, hypertension and dyslipidemia, is important. 

"To be more holistic, on top of liver-focused investigations and management, preventing cardiovascular disease as a whole is very important too as these individuals are at increased risk of heart attack and stroke," he said.

Dr Chan added that lifestyle changes after being diagnosed with fatty liver "can certainly help to improve the disease".

Edited by Rema Nambiar

BERNAMA