Leverfett

Leverfett, or hepatic steatosis, is the accumulation of fat within the liver, predominantly triglycerides stored in hepatocytes. Clinically, it is typically defined by a liver fat content exceeding about 5% of liver weight or by histological evidence of fat within liver cells. The condition ranges from simple fat accumulation without inflammation to more serious disease that can progress to steatohepatitis and fibrosis.

Main causes are alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD). NAFLD is strongly associated with obesity, insulin resistance, type 2 diabetes, dyslipidemia, and metabolic syndrome. Secondary or less common causes include medications (for example amiodarone, methotrexate, corticosteroids), rapid weight loss, malnutrition, and certain systemic conditions.

Pathophysiology involves an imbalance among fatty acid influx, de novo lipogenesis, fatty acid oxidation, and very-low-density lipoprotein (VLDL) export. Increased delivery of fatty acids to the liver, combined with enhanced fat synthesis and impaired fat export, leads to triglyceride accumulation. Oxidative stress and inflammatory signaling may promote progression from simple steatosis to non-alcoholic steatohepatitis (NASH) and fibrosis.

Diagnosis typically begins with imaging, such as ultrasound (which detects increased liver echogenicity) or MRI for quantification. Liver function tests may show mild elevations in ALT and AST, but they are not specific. Liver biopsy remains the gold standard for distinguishing simple steatosis from NASH and for staging fibrosis in selected cases.

Management focuses on treating underlying causes and lifestyle modification: weight loss, regular physical activity, abstinence from excess alcohol, and control of diabetes and lipids. There are no widely approved drugs specifically for fatty liver; some patients with NASH may benefit from certain medications under specialist guidance. Prognosis depends on progression to steatohepatitis and fibrosis, with cardiovascular disease representing a major risk in many patients.