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This article is the first in a series of 4 articles exploring the epidemic of liver disease called nonalcoholic fatty liver disease and its more severe form, nonalcoholic steatohepatitis.
Nonalcoholic fatty liver disease (NAFLD) is gaining more attention as a chronic medical condition, affecting approximately 25% of the worldwide population and 100 million individuals in the United States. NAFLD, is an umbrella term for a range of liver conditions that occurs as a result of fat in the liver.
This is in the absence of excessive alcohol use or other causes of fatty liver disease. Its more serious form is called non-alcoholic steatohepatitis (NASH), which affects 6-8% of the global population and is expected to increase 63% by 2030.
NAFLD can lead to inflammation of the liver, liver tissue damage and liver scarring (fibrosis), which can progress to cirrhosis and liver cancer (hepatocellular carcinoma). NAFLD is on track to become the leading cause of liver transplantation in the United States.
Patients with NASH typically have no or few symptoms, especially in the early stages of the disease. When a patient feels well, it can be challenging for physicians and caregivers to convince the patient that they may have a dangerous condition.
Rise in Risk Factors for Liver Disease
Obesity and type 2 diabetes mellitus are the leading risk factors for NAFLD. The rising population of NAFLD, closely mirrors the growing epidemic of obesity and type 2 diabetes mellitus. Presence of metabolic syndrome is also a risk factor for the development of NAFLD.
Several genetic predisposing factors are related to NAFLD and NASH; these genetic factors are most prevalent in Hispanics and associated with more aggressive disease. In individuals who do not develop cirrhosis, the leading causes of death are related to cardiovascular disease and non-liver related cancers.
Growing Need for Early Detection
The most accurate way to diagnose NAFLD and NASH and liver scarring is with a liver biopsy. This is invasive, can be expensive and has potential side effects. The need for non-invasive tests and point-of-care testing to diagnose and monitor assessment of liver fat and liver scarring are critical to helping identify individuals with NASH at risk of progression to cirrhosis.
Primary care physicians can play a central role in identifying at risk individuals because many patients with comorbidities, such as type 2 diabetes, are cared for by primary care physicians. In addition, they can assist in managing comorbidities such as obesity, type 2 diabetes and cardiovascular disease. Other subspecialties that see these patients are endocrinology, cardiology and bariatric medicine. There is a need to raise awareness on liver health.
The key message for caregivers is that NAFLD is manageable, and potentially reversible if caught in its early stages. Diet and exercise are the most effective treatments, but poor adherence often makes this a challenge for many people.
Part 2 of this series looks at current diagnostic tools and new non-invasive tests for liver disease. It will run on September 13.
Amreen Dinani, MD, is an Assistant Professor in the Department of Medicine, Division of Liver Diseases. Dr. Dinani’s clinical and research interests are in nonalcoholic fatty liver disease (NAFLD). She is an investigator for many ongoing clinical trials in NALFD.
George Therapondos, MD is the Hepatology Section Head at the Ochsner MultiOrgan Transplant Institute. He has published literature related to his research around advanced liver disease and its complications, such as portal hypertension and cirrhotic cardiomyopathy. His current research has focused on adult deceased and living donor liver transplantation and quality of life issues in liver patients.
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 American Liver Foundation (n.d.). Non-alcoholic fatty liver disease. https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/non-alcoholic-fatty-liver-disease/#facts-at-a-glance; accessed July 9, 2020.
 The NASH Education Program (n.d.). How prevalent is NASH? https://www.the-nash-education-program.com/what-is-nash/how-prevalent-is-nash/; accessed July 9, 2020.
Pan JJ, Fallon MB. Gender and racial differences in nonalcoholic fatty liver disease. World J Hepatol. 2014;6(5):274-283. doi:10.4254/wjh.v6.i5.274; accessed July 28, 2020.