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
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.
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