Wiki Fatty Liver

Case Study: Fatty Liver in a Non-Obese Patient

Patient Profile:

• Name: Emily Smith
• Age: 34 years
• Gender: Female
• Height: 5’6″ (167 cm)
• Weight: 140 lbs (63.5 kg)
• BMI: 22.6 (Normal Weight)

Medical History:

• No significant past medical history.
• Non-smoker, moderate alcohol consumption (1-2 drinks per week).
• Sedentary lifestyle with minimal exercise.
• Family history of liver disease and diabetes.

Presenting Symptoms:

• Emily visited her primary care physician for a routine check-up and reported mild fatigue and discomfort in the upper right abdomen.
• She denied any significant weight changes, jaundice, or changes in appetite.

Initial Assessment

Laboratory Tests:

• Liver Function Tests:
  • ALT: 95 U/L (normal range: 7-56 U/L)
  • AST: 78 U/L (normal range: 10-40 U/L)
• Lipid Profile:
  • Total Cholesterol: 190 mg/dL
  • LDL: 115 mg/dL
  • Triglycerides: 170 mg/dL (normal range: <150 mg/dL)
• Glucose Level: 98 mg/dL (normal range: <100 mg/dL)
• Insulin Level: 15 µU/mL (elevated, suggesting insulin resistance).

Imaging Studies:

• Abdominal Ultrasound: Revealed moderate hepatic steatosis (fatty liver) without evidence of fibrosis or cirrhosis.

Diagnosis

Based on Emily’s elevated liver enzymes, ultrasound findings, and family history, she was diagnosed with non-alcoholic fatty liver disease (NAFLD), despite being of normal weight.

Investigation of Causes

Given her non-obesity, the healthcare team performed additional assessments to investigate potential underlying causes:

• Genetic Testing: Identified a variant in the PNPLA3 gene associated with increased susceptibility to fatty liver disease.
• Metabolic Syndrome Screening: Found elevated insulin levels, indicating insulin resistance, and mild dyslipidemia.
• Thyroid Function Tests: Normal TSH and free T4 levels ruled out hypothyroidism as a contributing factor.

Management Plan

1. Dietary Modifications:
   • A referral to a registered dietitian was made to develop a personalized meal plan focused on:
     • Reducing refined carbohydrates and sugars.
     • Increasing fiber intake through fruits, vegetables, and whole grains.
     • Incorporating healthy fats, such as avocados and nuts, while minimizing saturated fats.
     • Adopting a Mediterranean diet as a guideline.
2. Exercise Program:
   • Initiated a structured exercise program with the goal of achieving at least 150 minutes of moderate-intensity aerobic exercise per week, incorporating both cardio and strength training.
3. Behavioral Interventions:
   • Engaged in stress management techniques, including mindfulness meditation and yoga, to address emotional eating and promote overall well-being.
4. Regular Monitoring:
   • Scheduled follow-up appointments every three months to monitor liver function tests, metabolic parameters, and assess adherence to lifestyle changes.

Follow-Up and Outcomes

3-Month Follow-Up

• Weight: Maintained at 140 lbs.
• Liver Function Tests:
  • ALT: Reduced to 60 U/L
  • AST: Reduced to 45 U/L
• Lipid Profile:
  • Total Cholesterol: 180 mg/dL
  • LDL: 105 mg/dL
  • Triglycerides: 140 mg/dL.
• Insulin Level: Improved to 10 µU/mL, indicating better insulin sensitivity.

6-Month Follow-Up

• Liver Function Tests:
  • ALT: 40 U/L
  • AST: 30 U/L (normal range).
• Ultrasound: Showed marked improvement with decreased hepatic steatosis.
• Physical Health: Emily reported increased energy levels and improved mood.
• Adherence: Continued commitment to dietary changes and regular exercise.

Conclusion

Emily’s case demonstrates that non-alcoholic fatty liver disease can occur in non-obese individuals, often linked to insulin resistance and genetic factors. Through a comprehensive approach that included dietary modifications, exercise, and behavioral interventions, she successfully reversed her fatty liver condition. This case highlights the importance of individualized treatment strategies that consider metabolic factors and family history, emphasizing that NAFLD is not solely a disease of obesity. Continued follow-up and lifestyle management are essential for maintaining liver health and preventing future complications.

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