GHS Cares: Fatty Liver Disease

10/5/2018

Obesity has grown to epidemic proportions in the Western World, with an estimated prevalence of 39.8% (93.3 million US adults) and $147 billion spent in annual healthcare costs. With obesity being an important risk factor for nonalcoholic fatty liver disease (NAFLD) and World Obesity Day being acknowledged on October 11th, I thought this would be an important topic to discuss.

NAFLD is the most common liver disorder, with studies reporting prevalence in the United States to be 10-46%. Apart from obesity, other risk factors for NAFLD include high blood pressure, diabetes and 
dyslipidemia (high triglycerides and lower high-density lipoprotein or HDL levels-commonly referred to as ‘good cholesterol’).

FACT #1: Most patients with nonalcoholic fatty liver disease do not have any symptoms. 

Though some patients may complain of fatigue and malaise, most cases come to light because blood tests revealed elevated liver enzymes (aminotransferases) and/or imaging tests such as ultrasound of the abdomen showed presence of increased fat in the liver. 

FACT #2: Nonalcoholic fatty liver is essentially a diagnosis of exclusion.

In addition to the demonstration of increased fat in the liver on imaging or biopsy, the diagnosis of NAFLD also requires the exclusion of significant alcohol consumption and other causes of fat infiltration of the liver (such as medication induced liver injury, hepatitis B and C, hemochromatosis, which is a condition with excess iron in the body. Also, autoimmune hepatitis, where the immune system turns against liver cells just as in rheumatoid arthritis and lupus). 

FACT #3: Nonalcoholic fatty liver disease can progress to cirrhosis and liver cancer. 


Patients with NAFLD are at risk for progression to cirrhosis (which refers to significant and advanced scarring in the liver). Studies estimate this risk to be between 10-16%. The risk is higher in patients with diabetes, older than 50 years, body mass index more than 28 kg/m², and with concomitant alcohol use. Patients with cirrhosis due to NAFLD are at an increased risk of liver cancer (12.8% over 3 years). 

FACT #4: Weight loss is the primary therapy for most patients with NAFLD.

Body mass index is defined as the body weight divided by square of the body height and is expressed in kg/m². Weight loss to less than 25 kg/m² can lead to improvement in liver tests and decrease fat accumulation and scarring in the liver. Diet modification and exercise form the cornerstone of interventions that can aid in weight loss. In addition, patients should refrain from the consumption of alcohol. Use of medications such as vitamin E for patients with NAFLD are limited to a small group of patients. 

In summary, fatty liver is extremely common and is potentially an important cause of significant health complications. Granville Gastroenterology Associates can address all of your liver related issues. 

Dr. Albin Abraham is a board-certified gastroenterologist expanding community access to quality care at Granville Gastroenterology Associates. Call 919.690.3499 or visit ghsHospital.org for more information. 


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