Fatty liver disease is defined as the buildup of excess in the liver. In the initial stages, fatty liver disease doesn’t provide a substantial health concern and is readily cured but as the condition continues, the liver experiences inflammation, damage, and the healthy tissues are replaced with scar tissue impacting the functioning of this vital organ.When this substantial damage develops, it is termed liver cirrhosis, and can further advance to liver failure or liver cancer. According to Dr. Ajitabh Srivastava, Director & Senior Consultant, Liver Transplant, Hepato-Pancreato-Biliary Surgery, Aakash hospital, “In India, obesity has become an epidemic. With obesity, many people develop Fatty Liver, which progresses naturally with the deposition of fat in the liver. This progression involves inflammation and fibrosis of the liver. Once fibrosis occurs, it becomes an irreversible step leading to cirrhosis. Liver cirrhosis is a dangerous disease to have, and patients with liver cirrhosis develop swelling of the abdomen due to fluid accumulation, known as ascites, and may also experience pedal edema. The development of these findings—fluid in the abdomen and swelling in the legs—is an ominous sign suggesting advanced cirrhosis. Some may require liver transplants. Individuals experiencing leg swelling should consult their liver doctor for evaluation to understand the severity of the liver disease, and appropriate action can be taken based on a final evaluation.”Dr Manoj Gupta, Head & Senior Consultant – Liver Transplant & G I Surgery, PSRI Hospital, says, “to measure severe obesity and identify conditions related to fatty liver. Swelling in certain body parts can indicate severe disease.The best and basic formula is “body mass index” (BMI), which involves the weight and height of a person. If the BMI is more than 30.30, it falls into the severe obese category. BMIs between 25 and 29 usually indicate overweight. Another method is measuring “waist circumference”, typically at the level of the umbilicus. In males, a measurement exceeding 94 cm, and in females, exceeding 88 cm, indicates obesity. Another aspect is the “Waist-to-Hip Ratio”, which compares waist and hip size. The waist ratio, as previously mentioned, and hip size, measured at the widest diameter at the level of the buttocks. If this ratio exceeds 0.9 in males and 0.85 in females, it indicates obesity. Other parameters like “Skinfold Thickness”, measured with calipers, can indicate obesity. Though not the most reliable marker, it can be measured at various body sites such as the trunk, hip area, or under the shoulder blade.Obesity is not solely about excess fat; it often accompanies associated illnesses such as diabetes, hypertension, high cholesterol levels, and obstructive sleep apnea, all of which are related to obesity. If a patient presents with these associated problems, it may indicate obesity, which can lead to fatty liver.”Fatty liver can be caused by either excessive alcohol intake (alcohol-induced fatty liver disease) or non-alcoholic fatty liver disease, which is caused by an unhealthy lifestyle and chronic illnesses such as obesity and diabetes. Cirrhosis is the last stage of fatty liver disease. Liver cirrhosis can induce swelling in several areas of the body which should not be taken lightly. Abdomen (ascites)The development of ascites is a telltale symptom of severe liver disease. Ascites is a collection of fluid in the abdominal cavity. In severe fatty NASH or advanced alcoholic fatty liver disease, liver inflammation and scarring can cause elevated pressure in the blood veins of the liver, a condition known as portal hypertension. This high pressure might cause fluid to seep from the liver’s blood veins into the abdominal cavity, causing swelling and pain.Legs and anklesOedema, often known as swelling in the legs, feet, or ankles, is one of the symptoms of liver disease. When the liver is not working properly, pressure builds up in its veins, causing this enlargement. The pressure inhibits blood flow in the liver, making the kidneys unable to remove too much salt from the body. Swollen veins in the feet and ankles should be taken carefully. Feet In certain people, swelling can move from the ankles to the feet. Swollen feet are sometimes seen as a result of a difficult day at work, however there may be underlying abnormalities causing recurring swelling in the feet.FingertipsClubbing of the fingers, in which the fingertips spread out and become rounder than usual, is a symptom of liver cirrhosis. One must immediately consult a doctor and get timely treatment if the condition persists.Chest and breastsMales with severe fatty liver disease may develop gynecomastia, a disorder characterized by breast tissue expansion. This develops as a result of hormonal imbalances linked to liver damage. This might be related with a decrease of sexual desire and infertility. How to manage fatty liver disease?Early identification and effective care are critical in the early stages of this disease, limiting the advancement of fatty liver disease (MAFLD) and its consequences. Lifestyle changes, such as eating a nutritious diet, exercising regularly, and minimizing alcohol use, can help manage fatty liver disease and lower the risk of serious complications. If you suspect fatty liver disease or are concerned about associated symptoms, visit a healthcare expert for an accurate diagnosis and treatment. To measure severe obesity and identify conditions related to fatty liver. 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