Introduction

Fatty liver disease is a condition that affects millions of people worldwide with a quickly rising prevalence. It occurs when there is an abnormal buildup of fat in the liver cells, which can lead to liver inflammation and damage.

Grade 1 fatty liver, also known as mild or simple fatty liver, is the least severe type of fatty liver disease. In this stage, the accumulation of fat in the liver cells is minimal and does not cause significant liver damage. However, it is essential to address this condition promptly as it can progress to more severe stages of fatty liver disease, such as grade 2 or 3.

Let us explore the causes, symptoms, diagnosis, and reversal strategies for grade 1 fatty liver to help maintain liver health.^1,7

Signs and Symptoms of Grade 1 Fatty Liver 

Grade 1 fatty liver, also known as mild fatty liver or simple fatty liver, may not cause any noticeable symptoms in most people. However, some people might experience the following signs and symptoms:

• Fatty liver disease can be asymptomatic until it advances to cirrhosis.
• Symptoms may include upper right abdominal pain or fullness.
• Other symptoms can include loss of appetite, nausea, and weight loss.
• Yellowing of the skin and eyes (jaundice) may also be present.
• Swelling in the abdomen and legs (oedema) can occur.
• Extreme tiredness, confusion, and weakness can also be symptoms of fatty liver disease.¹

It is essential to note that these symptoms are not specific to grade 1 fatty liver and can be indicative of other liver conditions or health problems. Therefore, it is crucial to consult a healthcare provider if you experience any of these symptoms or have concerns about your liver health.

Grade 1 Fatty liver disease is not dangerous if it is in the early stage as it is a mild condition (grade 1) where the fat deposition is less than one-third of the total liver (33%). Therefore, it can be reversible with the help of diet and physical exercise interventions, controlling lipid derangements, reducing weight and total alcohol abstinence.

Dr. M.G. Kartheeka, MBBS, MD

When to See a Doctor

It is essential to consult a healthcare provider if you experience any symptoms of fatty liver disease or have risk factors for the condition, such as obesity, insulin resistance, or excessive alcohol consumption. They can perform a thorough evaluation, order appropriate tests, and provide treatment or referral to a specialist if necessary. Early detection and management of grade 1 fatty liver disease can prevent the progression of the condition and maintain liver function.²

There are no proven medical treatments – yet – for non-alcoholic fatty liver disease. So that means that eating a healthy diet and exercising regularly are the best ways to both prevent liver damage from starting or reverse liver disease once it’s in the early stages.

Dr. Ashish Bajaj – M.B.B.S, M.D.

Causes of Grade 1 Fatty Liver

The exact causes of grade 1 fatty liver disease are not entirely understood. However, research has identified several factors that may contribute to the development of the condition. Grade 1 fatty liver disease, as well as more severe forms of fatty liver disease may be associated with:

• Being overweight or obese
• Insulin resistance, which impairs the body’s ability to respond to the hormone insulin and regulate blood sugar levels
• High levels of sugar in your blood, indicating diabetes or that you are at risk of diabetes
• Abnormal levels of fats in the blood, including high levels of triglycerides and abnormal cholesterol levels
• Metabolic syndrome, which is a group of traits and medical conditions linked to overweight and obesity
• Certain genes that may make a person prone NAFLD
• Diets high in fructose, a type of sugar commonly added to packaged drinks and foods
• Alcohol-associated liver disease due to excessive alcohol consumption Disorders that cause the body to use or store fat improperly
• Rapid weight loss or malnutrition
• Certain medications or exposure to toxins 
• Rare genetic diseases such as Wilson disease and hypo-betalipoproteinemia

These factors can contribute to the accumulation of fat in the liver cells, leading to grade 1 fatty liver disease.²

Medications like statins when used for a longer period of time, started early in the disease course and used at high doses have shown to be beneficial for managing signs of fatty liver clinically.

Dr. Ashish Bajaj – M.B.B.S, M.D.

Risk Factors for Grade 1 Fatty Liver

Grade 1 fatty liver disease may be associated with several risk factors, including:

• Increased triglyceride levels and cholesterol in the blood
• Metabolic syndrome, a group of conditions that include high blood pressure, high blood sugar, and excess body fat
• Obesity, especially when fat is concentrated in the abdomen
• Polycystic ovary syndrome
• Sleep apnoea
• Type 2 diabetes
• Underactive thyroid: When it’s underactive, it doesn’t produce enough of these hormones, leading to symptoms such as fatigue, weight gain, cold intolerance, constipation, dry skin, and depression. 
• Underactive Pituitary gland: When it’s not working properly, it can cause a variety of symptoms depending on which hormones are affected. If it’s not producing enough growth hormone, a person may have short stature; if it’s not producing enough thyroid-stimulating hormone, a person may have symptoms of an underactive thyroid (as mentioned above); if it’s not producing enough cortisol, a person may have fatigue, weight loss, and muscle weakness.
• Being postmenopausal

Identifying and managing these risk factors can help reduce the likelihood of developing grade 1 fatty liver disease and its associated complications.^1,2

Also Read: What Causes High Liver Enzymes: An Evidence-Based Overview

Diagnosis of Grade 1 Fatty Liver

The diagnosis of grade 1 fatty liver may not show any symptoms but can be detected during routine medical checkups or through tests conducted for other reasons. If the liver appears unusual on ultrasound or if there are abnormal liver enzyme test results, then additional tests may be ordered to determine the presence of fatty liver disease.

Diagnostic tests used to determine the diagnosis and severity of fatty liver disease include:

• Blood tests include liver enzyme and liver function tests, complete blood count, tests for chronic viral hepatitis, screening for celiac disease, fasting blood sugar, haemoglobin A₁C, and lipid profile.
• Imaging procedures such as abdominal ultrasound, CT scanning, or MRI of the abdomen, transient elastography, and magnetic resonance elastography.
• Liver biopsy may be recommended if other tests are inconclusive. This procedure involves removing a small sample of liver tissue using a needle, which is then examined for signs of inflammation and scarring.

It is important to note that liver biopsy carries small risks and may cause discomfort. The procedure is performed by inserting a needle through the abdominal wall and into the liver. Your doctor will discuss the procedure in detail with you and address any concerns you may have.³

Treatment of Grade 1 Fatty Liver

Currently, there is no medication specifically designed to treat fatty liver disease. Instead, doctors focus on managing contributing factors and recommending lifestyle changes that can improve overall health. The following treatments may be recommended:

• Abstaining from alcohol.
• Losing weight to reduce inflammation, fibrosis, and fat in the liver.
• Taking medications to keep diabetes, cholesterol, and triglycerides in control.
• Stopping the use of medications that are thought to contribute to NAFLD. Consult with a doctor before stopping medication, as a gradual process may be required or an alternative medication may be recommended.
• For those who have alcohol-related fatty liver disease, it is advised to consult a specialist and take part in an alcohol recovery programme. 
• Taking medications to reduce alcohol cravings or induce sickness if alcohol is consumed for those with alcohol-related fatty liver disease.
• Treating cirrhosis, a complication of both alcoholic and nonalcoholic steatohepatitis, with medication, surgery, or other medical procedures. In cases of liver failure due to cirrhosis, a liver transplant may be necessary.^1,5

Prevention and Reversal Strategies of Grade 1 Fatty Liver

At present, there are no established medical or surgical interventions available to treat fatty liver. However, there are some preventative and reversal strategies that can help alleviate the damage.

If you have fatty liver, you should:

• Safely lose weight by shedding no more than half to one kilogram (one to two pounds) per week.
• Lower your triglycerides through dietary changes, medication, or a combination of both.
• Avoid consuming alcohol.
• You should try to manage diabetes if diagnosed.
• Eating a balanced, healthy diet that limits salt and sugar and includes plenty of fruits, vegetables, and whole grains.
• Increase physical activity.
• Consult a liver specialist on a regular basis.
• Regular exercise and talking with your doctor before using any dietary supplements or herbal remedies are also recommended.

Overall, the best approach to preventing fatty liver disease is to maintain a healthy weight, engage in regular exercise, limit alcohol intake, and take medications as prescribed.^1,3,5

Complications of Grade 1 Fatty Liver

Here are some complications that may occur if grade 1 fatty liver is left untreated:

• The main complication of chronic liver disease is liver cirrhosis, which is caused by inflammation and leads to the production of scar tissue (fibrosis) in the liver. The effect of scar formation is the impairment of liver function.
• There may be accumulation of fluid in the abdomen, commonly known as ascites
• Swelling of veins in the oesophagus (oesophageal varices), which can rupture and cause bleeding
• Hepatic encephalopathy, which can cause confusion, drowsiness, and slurred speech
• Liver cancer
• End-stage liver failure, which means the liver is no longer functioning properly.⁴

Research Facts About Grade 1 Fatty Liver

Here are some interesting facts about grade 1 fatty liver diseases:

• According to studies, decreasing 10% of your body weight can reduce liver fat, inflammation, and, as a result, liver scarring.
• BARD score stands for “Bilirubin, AST, INR, and Creatinine Dialysis” score. It is a clinical scoring system used to predict the risk of mortality and the need for dialysis in patients with liver disease and kidney dysfunction. BARD score, a non-invasive way of predicting the likelihood of liver fibrosis, might be helpful in predicting liver fibrosis in Grade 1 fatty liver disease.^6,7

Also Read: How Long Does It Take to Reverse Fatty Liver: A Guide to Restoration and Recovery

Frequently Asked Questions(FAQ’s)

References

1. Fatty liver disease: Risk factors, symptoms, types & prevention [Internet]. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/15831-fatty-liver-disease
2. Symptoms & causes of NAFLD & Nash – NIDDK [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 10]. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes   
3. Department of Health & Human Services. Liver – fatty liver disease [Internet]. Better Health Channel. Department of Health & Human Services; 2007. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/liver-fatty-liver-disease#symptoms-of-fatty-liver-disease 
4. Definition & Facts of NAFLD & Nash – NIDDK [Internet]. U.S. Department of Health and Human Services; [cited 2023 May 10]. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts  
5. Fatty liver disease [Internet]. MedlinePlus. U.S. National Library of Medicine; [cited 2023May2]. Available from: https://medlineplus.gov/fattyliverdisease.html 
6. Irun Bhan M. Weight loss can help head off lasting damage caused by Fatty Liver [Internet]. 2020. Available from: https://www.health.harvard.edu/blog/weight-loss-can-help-head-off-lasting-damage-caused-by-fatty-liver-2020043019664  
7. Saran M, Sharma J, Ranjan A, Deka S, Sabharwal M, Palukari S, et al. A retrospective study to find out the correlation between NAFLD, diabetes, and obesity in Indian patients. Journal of Family Medicine and Primary Care. 2022 Jul;11(7):3504. 2212_21. Available from: https://journals.lww.com/jfmpc/fulltext/2022/07000/a_retrospective_study_to_find_out_the_correlation.18.aspx 

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