Fatty liver disease is not the actual disease

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Editor's note: When I first met Varun six years ago, it was regarding a baffling health concern. He had been 23 at the time, thin and underweight. A few weeks before, he had left nauseous and unwell, and had lost interest in food. In a routine clinical investigation, his liver tests were grossly abnormal. The liver enzymes alanine transaminase and aspartate transaminase were 514 and 338 IU/litre—much higher than a normal count of below 40. Varun had hepatitis—inflammation of the liver—but we ruled out all the common causes. He was a teetotaller. He had not consumed prescription medicines in the short or long term, and had tested negative for various infections and autoimmune disease that could cause hepatitis. Every test had been inconclusive until an imaging scan of the liver surprisingly revealed a severe grade-3 fatty liver. A liver biopsy confirmed our finding—that Varun’s hepatitis was due to severe fatty liver disease, medically known as steatohepatitis. His liver cells were packed with fat globules that were causing severe inflammation, leading to liver cell damage and an increase in enzymes, which was reflected …