Non-alcoholic fatty liver disease (NAFLD)

 

October is National Liver Awareness Month in the U.S, and it is NAFLD that has been gaining attention locally, as it is a growing problem in our community. With the advent of effective therapies for the treatment of hepatitis C virus (HCV), fatty liver disease is becoming more of an issue.

A recent study published forecasted an increase of 25% from the current burden of 5 551 000 cases in 2019, to 7 024 000 in 2030.1 The results of their analyses correlated with an increasing rate of obesity in Australia.

Metabolic syndrome is associated with a higher mortality risk than just patients with NAFLD. Metabolic syndrome is a combination of cardiovascular risk factors, including

– elevated serum triglyceride (TG)

– lowered serum high-density lipoprotein (HDL)

– impaired glucose tolerance

– central adiposity

– hypertension

Note that NAFLD is not officially included in the definition of metabolic syndrome, but that it often co-exists. Also, it is important to note that when patients with NAFLD have a BMI of > 35, they are at a much higher risk of developing cirrhosis.

Currently the only proven effective therapy for management of NAFLD is weight loss. If there are people with a BMI ≥ 35, who may be suffering from liver disease, then they need to speak to their local doctor. Bariatric surgery resolves non-alcoholic steatohepatitis (NASH), and is recommended for patients with a BMI ≥ 35.2 There are good resources online for the assessment of NAFLD, including imaging of the liver and excluding other causes.3

If patients are overweight, currently the only way to improve NAFLD is to drop the weight. There are many ways to do this, including modifying lifestyle factors, assessment with a dietitian and change in diet, exercise, and consideration of bariatric surgery.

For more information, do not hesitate to contact Dr Balalis.

 

 

 

 

References

  1. Nonalcoholic fatty liver disease burden: Australia, 2019-2010. Adams A, Roberts S et al. Journal of Gastroenterology and Hepatology 35 (2020) 1628-1635.
  2. Bariatric surgery in patients with non-alcoholic fatty liver disease – from pathophysiology to clinical effects. World Journal of Hepatology 2019; 11 (2) 138-149.
  3. Fatty Liver Disease: A Practical Guide for GPs. Australian Family Physician. Volume 42, No. 7, July 2013, 444-447.