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.