The silent liver dis­ease epi­demic

NAFLD is as­so­ci­ated with di­a­betes and weight rather than al­co­hol but can be pre­vented or re­versed through diet and ex­er­cise

The Irish Times - Tuesday - Health - - Front Page - Deirdre Falvey

They call it a silent epi­demic, and aware­ness of the risks of fatty liver have only be­come ap­par­ent very re­cently. Liver dis­ease is reg­u­larly as­so­ci­ated with ex­ces­sive al­co­hol use, but knowl­edge of Non-Al­co­holic Fatty Liver Dis­ease (NAFLD) is rel­a­tively less known. If un­di­ag­nosed and un­treated, it may ul­ti­mately lead to cir­rho­sis of the liver.

Those with type 2 di­a­betes, obe­sity/high BMI, a high in­take of fat and sugar (the ‘Western diet’) and/or high choles­terol have a greater risk of de­vel­op­ing NAFLD, but aware­ness among pa­tients and medics is ex­tremely low, so there’s un­der­diag­no­sis, un­der-treat­ment and in­creased mor­tal­ity.

Prof Suzanne Nor­ris, con­sul­tant hep­a­tol­o­gist at St James’s Hos­pi­tal and Liver Well­ness, is try­ing to raise aware­ness of the risks of fatty liver.

“It has really only come to fore in the past 10 years, and in the past two years NAFLD is the most com­mon dis­ease in western coun­tries.” In the past year, says Nor­ris, it is the most com­mon in­di­ca­tor for liver trans­plan­ta­tion for cir­rho­sis and liver can­cer in the US.

And yet peo­ple may have liver dis­ease with­out re­al­is­ing it. Last Novem­ber, Prof Nor­ris and Di­a­betes Ire­land of­fered liver screen­ing to pa­tients with type 2 di­a­betes. Of 48 who were scanned, 10 peo­ple – that’s more than one in five – had ad­vanced fi­bro­sis/cir­rho­sis of the liver. Of those 10, eight had nor­mal liver func­tion tests, nine were light or non-drinkers, five had at least one fea­ture of meta­bolic syn­drome, and all 10 had se­vere fatty liver in­fil­tra­tion.

Over­weight na­tion

With Ire­land set to be­come the most over­weight na­tion in Europe by 2025, NAFLD in Ire­land is likely to in­crease sig­nif­i­cantly.

How do you gauge how preva­lent the silent epi­demic may be? There is no liver pop­u­la­tion base study of fatty liver in Ire­land, so re­searchers ex­trap­o­late from Tilda [The Ir­ish Lon­gi­tu­di­nal Study on Age­ing] and look at other coun­tries, where 30 per cent of the gen­eral pop­u­la­tion is at risk for NAFLD, says Nor­ris.

Also, 70 per cent of peo­ple with type 2 di­a­betes in­ter­na­tion­ally have fatty liver. “It would be no dif­fer­ent here. Most peo­ple are un­aware of it.” Some 90 per cent of the 225,000 peo­ple in Ire­land who have di­a­betes are type 2.

The ma­jor­ity with NAFLD may have no prob­lem but 20-25 per cent will go on to de­velop Non-Al­co­holic Steato-Hep­ati­tis (NASH), which is in­flam­ma­tion and cel­lu­lar dam­age in re­sponse to the liver fat. Those pa­tients are at high­est risk of cir­rho­sis.

“We are try­ing to get the mes­sage out to other med­i­cal spe­cial­i­ties, par­tic­u­larly those who treat peo­ple with di­a­betes, be­cause aware­ness of NAFLD is low, and com­pli­ca­tions are po­ten­tially very se­ri­ous.”

There is no FDA-ap­proved drug avail­able to treat NASH (though there are cur­rently 60 international clin­i­cal tri­als), so life­style mod­i­fi­ca­tion and weight-loss are the only op­tion.

“What wor­ries me,” says Nor­ris, “is see­ing peo­ple with a di­ag­no­sis of fatty liver cir­rho­sis, who, if they had been ad­vised five years ago to lose weight, could have off­set this risk. Re­search shows los­ing 7-10 per cent of body weight leads to a ma­jor im­prove­ment in liver fat, in­flam­ma­tion and liver scar­ring. Anec­do­tally I have seen peo­ple re­verse early cir­rho­sis with weght-loss.”

Ciarán Law­less: re­versed the dam­age to his liver through diet and ex­er­cise

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