Non-Alcoholic Fatty Liver Disease (NAFLD) is linked to an increased risk of developing several secondary health conditions, including cancers outside the liver, according to new findings. The problem is, diagnosis is difficult: NAFLD is often asymptomatic, which makes it difficult to catch this growing disease in its early stages.
In this article, we’ll look at the complications of ignoring NAFLD, then offer some tips on managing it and spotting the symptoms before the disease triggers secondary problems.
What is NAFLD?
NAFLD refers to a range of liver problems that affect those who drink little to no alcohol. It’s becoming increasingly common, especially in countries where obesity is a problem. In the U.S., it affects approximately 25% of the population.
Some of those with NAFLD go on to develop nonalcoholic steatohepatitis (NASH). This may then lead to scarring (cirrhosis) and liver failure.
Cirrhosis means valuable liver tissue is taken up with scar tissue, limiting its ability to effectively process toxins (Image Source).
CNBC reports that deaths from chronic liver disease and cirrhosis have risen every year since 2007. It is now among the top 12 leading causes of death for Americans.
Symptoms
Most people with NAFLD experience no symptoms beyond mild fatigue and abdominal pain, usually on their right side. “This is a silent disease and typically there are no symptoms until it is advanced (it can lead to cirrhosis),” says Dr. Sumit Kapoor, a gastroenterologist at OhioHealthDoctors Hospital in Columbus, Ohio.
Symptoms of NASH and cirrhosis include:
- Yellowing of the skin and eyes (jaundice)
- Abdominal swelling
- Red palms
- Enlarged blood vessels beneath the skin’s surface
- An enlarged spleen
Risk Factors of NAFLD and NASH
Experts haven’t agreed on one single cause, and there’s limited understanding of why some with NAFLD go on to develop NASH and cirrhosis while others don’t. That said, there are a number of health conditions linked to both NAFLD and NASH:
- Obesity
- High levels of fats (triglycerides in particular) in the blood
- Insulin resistance
- High blood sugar and Type 2 Diabetes
- High cholesterol
- Sleep apnea
- Metabolic syndrome
- Polycystic ovary syndrome
- Underactive thyroid (hypothyroidism)
- Underactive pituitary gland (hypopituitarism)
All of these symptoms promote the deposit of fat in the liver, which can lead to inflammation and a buildup of scar tissue.
NAFLD—and especially the more progressive form of the disease—is predominantly linked to obesity.
“Obesity and diabetes rates are very high in the U.S. and are also increasing worldwide,” says Dr. Rohit Loomba, chairman of the American Liver Foundation’s National Medical Advisory Committee. “So when we look at the rising rates of NASH in people who don’t drink and don’t have hepatitis C yet are still developing cirrhosis of the liver, we know something is damaging the liver and we’re not containing it.” He adds that 90% of the patients diagnosed with NASH are either overweight or obese.
How NAFLD and NASH Are Diagnosed
It’s difficult to identify NAFLD and NASH without testing. Dr. Jay Horton, director of the Center for Human Nutrition at UT Southwestern Medical Center, says an individual will usually find out they have NAFLD during a liver function test or if they have an abdominal scan for some other reason, such as gallstones. “Even though they’re finding out about it almost by accident, it’s actually very easy to detect excess liver fat with an imaging modality, such as an MRI, CT scan or ultrasound,” he adds.
A biopsy is currently the gold standard when it comes to diagnosis. However, they are expensive and come with a small risk of bleeding. “Although this invasive test could be performed by hepatologists, the number of these specialists who have both the expertise and comfort to execute, order or interpret a liver biopsy is very low as compared to the number of suspected NASH patients,” says Pascaline Clerc, the U.S. campaign manager for the NASH Education Program. “Nonetheless, noninvasive tests like an ultrasound or MRE are recommended by the current guidelines of the American Association for the Study of Liver Diseases.”
Complications
The main complications of NAFLD include cirrhosis, which, if left untreated, means scarring takes up more and more liver tissue, reducing its function. If this process isn’t stopped, it can lead to more complications, including:
- Fluid buildup in the abdomen (ascites)
- Confusion, drowsiness, slurred speech (hepatic encephalopathy)
- Swelling of veins in the esophagus (esophageal varices), which may rupture and bleed
- Liver cancer
- End-stage liver failure
- Non-liver cancers
“This large meta-analysis suggests that NAFLD is associated with a moderately increased long-term risk of developing extrahepatic cancers over a median of nearly six years (especially GI cancers, breast cancer and gynecological cancers),” says Giovanni Targher, MD, of the University of Verona in Italy.
Studies also show that NAFLD can be passed down from generation to generation. “What o
ur study is saying is that maternal pre-pregnancy obesity is causing an early life effect to prime the [offsprings’] livers to develop fatty liver, making them vulnerable to environmental hits such as a hyper-calorific diet, or a western diet, which will increase their risk of developing more advanced liver disease,” said Dr. Kushala Abeysekera, of the University of Bristol.
How to Prevent NAFLD and NAFLD-Related Complications
Dr. Horton says lifestyle changes are still the most effective first-line approach for dealing with the disease.
“Weight loss works, whether through a bariatric procedure or a strict dietary approach,” he says. “Even an 8 percent to 10 percent weight loss seems to improve liver fat.”
“Stay thin,” he adds. “The key is insulin resistance related to obesity. Anything that helps you to stay thin and have normal insulin sensitivity will prevent this disease.”
- Choose a healthy diet that’s rich in vegetables, fruits, grains, and healthy fats.
- Keep your weight down through exercise, healthy eating, and reduced calorie intake.
- Speak to a healthcare provider for tips and advice. This could range from diet help to checkups and Remote Patient Monitoring if you already have chronic NAFLD and are looking to manage your symptoms remotely.
ChronWell offers a wide range of digital health and clinical solutions to help healthcare providers diagnose and treat NAFLD and provide chronic care management. Practitioners can provide round-the-clock support while also allowing patients to receive healthcare no matter where they are.
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If you want to find out how ChronWell can help your practice provide better support and operate more efficiently, contact an expert today.
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