Steatotic Liver Disease

What is steatotic liver disease?

Your liver is the largest organ inside your body. It helps you digest food, store energy, and remove harmful substances (toxins). Steatotic liver disease, formerly called fatty liver disease, happens when too much fat builds up in your liver. It's typical to have some fat in your liver cells, but too much can be a problem.

There are two main types of steatotic liver disease:

• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Alcohol-associated liver disease (ALD)

MASLD is a type of steatotic liver disease that is not caused by heavy alcohol use. It used to be called nonalcoholic fatty liver disease. There are two main forms:

• Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver damage. This form usually does not get bad enough to cause liver damage or complications.
• Metabolic dysfunction-associated steatohepatitis, or MASH (previously called nonalcoholic steatohepatitis or NASH), is when MASLD gets worse. In addition to fat in your liver, MASH may cause inflammation and liver damage. This can lead to fibrosis, or scarring, of the liver. This scarring sometimes leads to cirrhosis or liver cancer.

ALD is caused by heavy alcohol use. It used to be called alcoholic fatty liver disease, or alcoholic steatohepatitis.

Your liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can create harmful substances. These substances can damage liver cells, cause inflammation, and weaken your body's natural defenses. The more alcohol that you drink, the more you damage your liver. ALD is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

The cause of MASLD is unknown, but it is more common in people who:

• Have type 2 diabetes and prediabetes
• Have obesity
• Are middle aged or older (although children can also get it)
• Have high cholesterol or triglycerides
• Have high blood pressure
• Take certain medicines, such as corticosteroids and some cancer medicines
• Have certain metabolic disorders, including metabolic syndrome
• Have rapid weight loss
• Have certain infections, such as hepatitis C
• Have been exposed to certain harmful substances

MASLD is the most common chronic (long-term) liver disease due to increasing rates of obesity, type 2 diabetes, and high cholesterol.

ALD only happens in people who are heavy drinkers, especially those who have been drinking for a long period of time. The risk is higher for people who drink heavily and are women, have obesity, or have certain gene changes (known as variants or mutations).

Both MASLD and ALD usually have few or no symptoms. If you do have symptoms, you may feel tired or have discomfort in the upper right side of your abdomen (belly).

Because there are often no symptoms, it's not easy to find steatotic liver disease. Your health care provider may suspect you have it if you have abnormal results on liver tests. To make a diagnosis, your provider may use:

• Your medical history. This may include asking about your alcohol use and any medicines you take.
• A physical exam. This may include checking your height and weight. Your provider may also check your body for signs of liver disease such as an enlarged liver or jaundice, a condition that causes your skin and whites of your eyes to turn yellow.
• Blood tests. These may include liver function tests and blood count tests.
• Imaging tests. These tests may be used to check for fat in the liver and for fibrosis.
• A biopsy. In some cases, a biopsy may be done to confirm the diagnosis and check for liver damage.

The first step in treating MASLD is usually weight loss. Losing weight can reduce fat in the liver, inflammation, and fibrosis. If your provider thinks that a certain medicine is the cause of your MASLD, they may tell you to stop or switch medicines. But don't stop taking any medicines unless your provider tells you to.

More studies are needed to see whether certain medicines are safe and effective to treat MASLD. Currently, no medicines are approved for treatment.

The most important part of treating ALD is to stop drinking alcohol. If you need help, you may benefit from counseling, a recovery program, or medicines that reduce cravings or make you feel sick if you drink alcohol.

Both ALD and one type of MASLD can lead to cirrhosis. Health problems caused by cirrhosis may be treated with medicines, surgery, and other medical procedures. If cirrhosis leads to liver failure, you may need a liver transplant.

If you have any type of steatotic liver disease, there are some lifestyle changes that can help:

• Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains.
• Talk with your provider about vaccinations. If you have chronic liver disease you are more likely to get infections. Your provider may recommend vaccinations for hepatitis A and B, the flu and pneumococcal disease.
• Get regular exercise, which can help you lose weight and reduce fat in the liver.

Check with your provider before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some supplements or herbal remedies can damage the liver.

Toddler Health

Most young children get sick. It is hard for parents to know what is serious. You can learn what the common warning signs are. In the end, trust your intuition. If you are worried about your toddler, call your health care provider right away.

Well-child visits are important to your toddler's health. Toddlers will get their recommended vaccines during these visits. Routine exams and screenings help you and your kids prevent and treat health problems as well as chart their growth and development.

Traveler's Health

Traveling can increase your chances of getting sick. A long flight can increase your risk for deep vein thrombosis. Once you arrive, it takes time to adjust to the water, food, and air in another place. Water in developing countries can contain viruses, bacteria, and parasites that cause stomach upset and diarrhea. Be safe by using only bottled or purified water for drinking, making ice cubes, and brushing your teeth. If you use tap water, boil it or use iodine tablets. Food poisoning can also be a risk. Eat only food that is fully cooked and served hot. Avoid unwashed or unpeeled raw fruits and vegetables.

If you are traveling out of the country, you might also need vaccinations or medicines to prevent specific illnesses. Which ones you need will depend on what part of the world you're visiting, the time of year, your age, overall health status, and previous vaccinations. See your doctor 4 to 6 weeks before your trip. Most vaccines take time to become effective.

Centers for Disease Control and Prevention

Valley Fever

Valley Fever is a disease caused by a fungus (or mold) called Coccidioides. The fungi live in the soil of dry areas like the southwestern U.S. You get it from inhaling the spores of the fungus. The infection cannot spread from person to person.

Anyone can get Valley Fever. But it's most common among older adults, especially those 60 and older. People who have recently moved to an area where it occurs are at highest risk for infection. Other people at higher risk include:

• Workers in jobs that expose them to soil dust. These include construction workers, agricultural workers, and military forces doing field training.
• African Americans and Asians
• Women in their third trimester of pregnancy
• People with weak immune systems

Valley Fever is often mild, with no symptoms. If you have symptoms, they may include a flu-like illness, with fever, cough, headache, rash, and muscle aches. Most people get better within several weeks or months. A small number of people may develop a chronic lung or widespread infection.

Valley Fever is diagnosed by testing your blood, other body fluids, or tissues. Many people with the acute infection get better without treatment. In some cases, doctors may prescribe antifungal drugs for acute infections. Severe infections require antifungal drugs.

Centers for Disease Control and Prevention

Viral Infections

What are viruses?

Viruses are very tiny germs. They are made of genetic material (either DNA or RNA) inside of a protein coating. There are a huge number of viruses on earth. Only a small number of them can infect humans. Those viruses can infect our cells, which may cause disease. Some of the diseases that viruses can cause include the common cold, the flu, COVID-19, and HIV.

Viruses can be spread in different ways:

• Through droplets and particles that are breathed out by someone who has the infection. You might breathe in the droplets or particles, or they could land on your mouth, nose, or eyes.
• By touching surfaces or objects that have the virus on them and then touching your mouth, nose, or eyes.
• From the pregnant parent to the baby during pregnancy.
• Through contaminated food or water.
• By being bitten by an infected insect or animal.
• Through sexual contact (usually vaginal, anal and oral sex) with someone who has the infection.

Viruses are like hijackers. They invade living, normal cells. They then use those cells to multiply (make copies of themselves). This process is also called replication. The process can kill, damage, or change the infected cells. Sometimes this can make you sick. The symptoms can range from mild to very severe. Other times, your immune system may be able to fight it off and you may not have any symptoms.

Each different virus usually only infects one type of cell in your body. For example, hepatitis viruses affect the cells in the liver. HIV infects a certain type of immune system cell.

For most viral infections, treatments can only help with symptoms while you wait for your immune system to fight off the virus. There are antiviral medicines to treat some viral infections. Antibiotics do not work for viral infections.

Vaccines can help prevent you from getting many viral diseases. You may be able to prevent some viral infections by:

• Proper hand washing.
• Paying attention to food safety.
• Cleaning surfaces that may be infected with germs.
• Avoiding contact with wild animals.
• Preventing insect bites by using insect repellent when you go outdoors. If you travel to an area that has a high risk of diseases from insect bites, also wear long pants, shirts, and socks.
• Practicing safe sex (using a condom every time you have anal, vaginal, or oral sex).
• Avoiding close contact with people who are sick.