While I am not a fan of using the term “silent killer” when it comes to talking about liver disease, more and more, I do believe this is part of the conversation that I need to have with my patients.
Fatty liver disease, also known as non-alcoholic fatty liver disease (NAFLD), is a true public health crisis. Considering it has very few symptoms that would tip one off that you are having trouble with your liver, all too often, this condition is under-diagnosed, under-treated, and completely unappreciated until serious life-threatening complications develop. Over the past decade, non-alcoholic fatty liver disease has become the most chronic liver condition in the United States.
The increasing number of cases a fatty liver disease is directly linked to the increase in obesity we see in both adults and adolescents. As more people become obese, more cases of fatty liver disease are seen. The result? There is an increase in serious complications associated with fatty liver disease such as cirrhosis, liver cancer, and liver failure. Being a liver disease specialist, I see patients every day with late stage complications. Unfortunately, they have known about their elevated liver chemistries and fatty liver anywhere between 5 and 10 years earlier-without treatment.
Many primary care physicians that identify patients with fatty liver simply are unaware of the potentially serious complications that develop. You need to take action now. Likewise, the general public when told that they have fatty liver, really don’t know what to make of it. They are unclear with regard to not only the complications, but the need to make important lifestyle changes. These lifestyle changes, such as weight loss, addressing glucose abnormalities, and the avoidance of alcohol, can be lifesaving.
While NAFLD is classified as a liver disease, it is also a significant driver of cardiovascular complications, the development of diabetes, kidney disease, and premature death. Instituting a treatment plan for the fatty liver disease will also slow down the other non-liver complications associated with heart disease and diabetes. In a sense, the diagnosis of non-alcoholic fatty liver disease is the tip of the iceberg for other associated conditions.
Risk factors for non-alcoholic fatty liver disease include truncal obesity (the all familiar belly fat), hypertension, insulin resistance or type 2 diabetes, and elevated blood lipids (cholesterol and triglycerides). Collectively, this is called “metabolic syndrome”. Fatty liver is the liver manifestation of metabolic syndrome.
Making the diagnosis of non-alcoholic fatty liver disease requires a high index of suspicion. If you are obese, have type 2 diabetes, and other elements of metabolic syndrome, there’s a high probability that you have fatty liver. The presence of elevated liver chemistries on your routine blood work would further confirm the diagnosis. Screening with an ultrasound is likely to find changes of fat in the liver. It’s estimated that 20% of those with fatty liver disease will develop a more aggressive form of the disease. This is called NASH. NASH presents with inflammation in the liver. This put you at risk for the development of fibrosis and scarring in the liver. Liver scarring can lead to cirrhosis.
There is a simple online calculation called the Fibrosis-4 index, also called Fib-4. This can provide you with a high degree of confidence whether or not there is fibrosis in the liver. Other noninvasive testing, short of a liver biopsy, includes the vibration controlled transient elastography, also known as fibroscan. In select cases, a liver biopsy maybe a very valuable test to perform.
The key takeaway message is that if you have risk factors for non-alcoholic fatty liver disease, including metabolic syndrome, you need to be evaluated further by your primary care physician or be seen by a liver specialist. A well-trained eye can determine whether or not there is more damage taking place. You may be at high risk for serious complications.
Individuals with fatty liver disease need to realize that their own personal accountability with regard to diet and obesity needs to be addressed as well. This can be a reversible situation. Losing 10% of your body weight will have meaningful improvement in your liver function and outcome. There are a number of new medications that are actively being tested here in the United States and abroad to aid in the management of this potentially devastating liver condition.
As I mentioned at first, fatty liver disease is a silent killer, and the liver suffers in silence. Ignoring one’s risk factors, abnormal blood work related to the liver, or a scan that is suggestive of a fatty liver, will only result in future complications. This is a disease that can be turned around and with the support and guidance from your treatment team, outcomes can be improved.