One in four people in Malaga province has fatty liver disease, a dangerous condition with no warning signs

Fatty liver disease or hepatic steatosis is the accumulation of fat in the hepatocytes cells in the liver tissue. This can be caused by an unbalanced diet or alcohol abuse and it is a pathology with a very high prevalence. Experts estimate that one in four people in Malaga province suffers from this disease. There are, however, other ailments such as obesity or type 2 diabetes that also create a breeding ground for its development.

"If a person tells you: 'No, doctor, I don't drink any alcohol', perhaps what may be wrong is their type of diet," says Dr Alegría - head of digestive system at HM Hospitales in Malaga. As he explains, "it is a completely asymptomatic disease in its initial stages", which means that one would not be aware that they have it unless they go to a health centre and get diagnosed.

According to Dr Alegría, of the 25% of the population who already have a fatty liver, one in three enter the stage called steato hepatitis, which means that "the presence of fat inside the liver is already generating inflammation". As we know, without a change of lifestyle, "all chronic inflammation can lead to something else".

Once the liver is inflamed, scarring occurs and the organ becomes stiffer. Of those who suffer from inflammation, about a third could end up with cirrhosis and, of these, 2% face liver cancer or hepatocarcinoma. "So, yes, it is a dangerous disease, very prevalent; it can be dangerous if we don't diagnose it and find a solution," says Dr Alegría.

The prevalence of liver cancer among those who started out with fatty liver "is not that high, but there is an increased risk, not to mention if this is associated with alcohol intake, smoking or other diseases that also inflame the liver".

Nutrition is the key to combat this pathology, given that diseases such as obesity or type 2 diabetes can also lead to a fatty liver. "Nutrition is very important: healthy food, daily exercise and taking care of yourself," says the doctor, acknowledging that leading a healthy lifestyle requires effort, but insisting that it is essential. He also adds that alcohol consumption, although not banned, should be limited to a minimum. "I don't like to be strict," says Dr Alegría, highlighting that a good diet and a beer only from time to time can reduce the risk.

"The important thing is to recognise liver fibrosis at an early stage, because if this inflammation has already led to fibrosis, it becomes like a scar: this scar does not go away, it does not recover, but it can continue growing," he says. However, if detected early, the inflamed liver can be saved. "The first thing is to reduce inflammation, remove the fat and try to return the liver to a somewhat normal state. It is essential to find that point of no return so that we don't get there," he says.

According to Dr Alegría, the disease is extremely common, especially in people over 25 years of age, and even more so in those in their fifties and sixties. "Just today, I have seen 20 patients and at least three of them had fatty liver disease without knowing it," he says.

For diagnosis, the usual blood test in a routine medical examination is not enough. What is necessary are a liver profile with GGT and transaminases, "which tells us if there is inflammation". Afterwards, ultrasound provides the necessary support to confirm the existence of fat in the liver and, if the aim is to find out whether the organ has been inflamed for a long time, a FibroScan is applied - "a device that, by means of small touches, just above the liver, which is in the upper right part of the abdomen, just below the ribs, measures the rigidity of the organ in degrees. If these are low, the organ is normal; and if you have stiffness, a FibroScan with very high values may be indicating cirrhosis". Some experts even add the importance of performing a liver biopsy.

It is a disease that is growing all the time. "I think it is happening more and more at a global level, due to chain production, processed food, fast food, stress," says Dr Alegría. It is awareness and research that provides us with hope.