Fatty Liver Disease

Non-alcholic fatty liver disease (NAFLD) occurs when excess fat accumlates in the liver in the absence of high alcohol intake. NAFLD is on the rise in the population, affecting 30% of adults worldwide, and 55% of people with type 2 diabetes.

Why it happens:

• As we consume excess energy and store fat, our "healthy fat storage" under the skin becomes full, and the excess fat begins to accumulate in other organs like the liver
• Risk factors for NAFLD include sedentary lifestyle, gaining weight, type 2 diabetes/prediabetes, elevated blood triglycerides or low HDL cholesterol, high blood pressure

How it shows up:

• The two most common reasons NAFLD is discovered is abnormal blood test results (ALT above 30 U/L in men or 25 U/L in women) or excess liver fat seen on imaging like ultrasound or MRI

Why it matters:
Some people with NAFLD will have progressive abnormalities in the liver that can lead to liver failure

• NASH (non-alcoholic steatohepatitis). NAFLD with inflammation in the liver
• NASH with fibrosis. NAFLD with inflammation and scarring.
• Cirrhosis. NAFLD with inflammation, scarring, and permanent destruction of liver tissue

NAFLD/NASH is one of the most common causes of liver failure requiring liver transplant. Additionally, people with NAFLD are at a higher risk for cardiovascular disease and multiple types of cancer.

What you can do if you have NAFLD:

• Eat healthy food and lose weight if overweight
• Get regular exercise
• Avoid or limit alchohol
• Avoid medications that might harm the liver
• Talk with your provider about your risk for more advanced liver disease, in which case medications (pioglitazone, semaglutide) or referral to a liver specialist might be recommended

Maintaining a healthy lifestyle and body weight are the best approaches to avoiding NAFLD in the first place. We only get one liver. It's important to take care of it.

Going Deeper:
UpToDate information about NASH

Have a great week,

Dr. Topher Fox

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P.P.S. Below are the pictures from my exam room wall which we are exploring for this email series.