Liver disease: the fat facts
As liver transplants are the only cure for advanced disease, weight loss is encouraged
Hilary Todd was astonished when doctors told her in December 2015 that she needed an urgent liver transplant. “I felt fine,” she says, “I told them, I’m not ill.”
Yet, the 53-year-old, who lives in the UK had non-alcoholic fatty liver disease (NAFLD) caused by a build-up of fat which, over time, caused the liver to fail.
Having never drunk alcohol, and being overweight, but fit from running around the playgroup she ran and from looking after her own children, the diagnosis “was a surprise” – all the more so when she was told she needed to get on the transplant list while she was still well enough to have the operation. “By the time I was ready in October 2016, my main hepatic portal vein was so blocked, I was [almost] inoperable.”
Todd had an advanced case of fatty liver disease – in about 12% of cases, NAFLD develops into non-alcoholic steatohepatitis or Nash which can lead to liver cirrhosis and cancer.
“Alcohol is still the most common cause for liver disease,” says Dr Phil Harrison, consultant hepatologist at London Bridge Hospital’s Liver Centre, “but it’s closely followed by NAFLD.”
He puts this down to the rise in obesity and cases of type 2 diabetes, both of which predispose to NAFLD, leading the condition to become “almost an epidemic”.
Most cases have a BMI of over 30, classifying them as obese. But NAFLD also shows up in the overweight category.
Professor Jonathan Fallowfield, senior clinical fellow and honorary consultant hepatologist at the University of Edinburgh, says people “don’t realise the significance” of what is happening, and are only usually diagnosed after being “picked up with abnormal liver tests after being probed for something else”. They’re often overweight but may have no symptoms.
Men are more likely to suffer NAFLD, with older people, lower-income families and boozers most at risk. But it can affect anyone. It was a contributing factor to the death of singer George Michael.
It’s not fully understood yet, says Harrison. “The fat which gets deposited is not the same as around the waist. It gets into the liver cells where it can stop the liver from detoxifying. Often, liver disease progresses insidiously for years building into inflammation. In time, the worst symptoms are brain confusion, jaundice or bleeding.”
Bleeding was the first symptom Todd suffered, but as it started when she was 43 – most people are not considered at risk until 50 – doctors couldn’t detect an underlying problem. After a family trip to a swimming pool 10 years ago with her children, “I threw up a sink full of blood in the changing room. It was frightening.”
She was taken to hospital with a suspected bleeding ulcer, and had a stroke the next day. After three days in intensive care, she was diagnosed with oesophageal varices (enlarged veins in the gullet) but liver biopsies – the most effective way to diagnose – were inconclusive. She spent the following seven years being monitored regularly, but it was only in late 2015, when a blood test indicated her condition had deteriorated, that Todd was placed on the transplant list.
As liver transplants are the only cure for advanced disease, doctors encourage weight loss.
“It’s crucial to remember that much liver damage is reversible,” says Fallowfield. “When people lose between seven and 10% body weight through dieting or weight-reduction surgery, NASH resolves dramatically. It’s never too late.” Sugar is a problem, Harrison adds. NASH is becoming increasingly common among children. “By 2020, it’s estimated half of all children will be overweight or obese,” which, Fallowfield explains, “is down to both environmental and genetic factors. But in many cases it’s an entirely preventable illness.” Work is now going on to establish how the disease progresses from fat in the liver to cirrhosis.
“If we can work out what makes NAFLD develop into a serious problem in some people, we can find new treatments.” Until then, patients like Todd have no choice but to hope for a liver transplant.