Fatty liver disease is a direct result of our nation’s obesity epidemic. Approximately 20% of adults and 10% of children have NAFLD. But the rates in those over 60 years of age are above 40%. People with type 2 diabetes and prediabetes are especially susceptible, where as many as two out of three have a fatty liver. NAFLD is like alcoholic liver disease but can happen in people who rarely or never drink. About 7% of people with fatty liver disease will progress to nonalcoholic steatohepatitis or NASH. When this happens, liver cells become injured and inflamed and form scarring known as fibrosis. Fibrosis leads to cirrhosis and increases the risk for liver cancer. People with diabetes have faster progression to NASH and liver scarring. NAFLD is often a silent disease with few or no symptoms. NAFLD can cause fatigue which may be overlooked during a medical evaluation for tiredness. Other symptoms include nausea, yellowing of the eyes or discomfort in the upper right side of the abdomen. NAFLD is suspected by abnormal liver tests, primarily elevated liver tests (AST-aspartate aminotransferase, ALT-alanine aminotransferase), high ferritin or low platelets. Suspected NAFLD is then confirmed with an imaging study such as ultrasound, CT, or MRI of the abdomen. Traditionally, the diagnosis of NASH has been made by liver biopsy, but this can be painful and expensive. New noninvasive tools have become another way to detect fibrosis in patients with fatty liver disease. The management of NAFLD consists of treating liver disease alongside the associated metabolic conditions such as obesity, diabetes, and abnormal cholesterol. Weight loss is one of the most effective treatments for NAFLD while improving all the metabolic conditions and decreasing the risk of heart disease. Although there are no approved drug therapies for NAFLD, some diabetes medications and vitamin E have been shown to be effective. Weight loss medications are also beneficial for NAFLD although there is little research. A type of weight loss surgery known as metabolic surgery is an effective treatment. New pharmaceutical agents that directly target NASH are in clinical trials. Liver transplantation is also a treatment for patients with end stage liver disease. Early detection allows people to make lifestyle changes, lose weight and be treated with medications that can reduce or reverse progression. Weight loss of 7% can reduce liver fat and inflammation in most patients.
