2020 taught us a lot, and as the clock struck midnight New Year’s Eve, perhaps we all gave thanks we made it to 2021 with our health intact and with a renewed focus on maintaining it.
While many of us dust off our running shoes or start meal planning this time of year, it may surprise some that benefits will extend far beyond the waistline.
While COVID is rightfully a major focus, it turns out that there is another pandemic that has been brewing for years with no vaccine in sight: non-alcoholic fatty liver disease (NAFLD).
NAFLD is a condition in which excess fat is stored in the liver and buildup is NOT caused by heavy alcohol use. Two types of NAFLD are recognized: simple fatty liver and nonalcoholic steatohepatitis (NASH), separate conditions with distinct outlooks.
Simple fatty liver is a form of NAFLD in which there is fat in the liver but little or no inflammation. Simple fatty liver typically does not progress to cause liver damage.
NASH is the other form of NAFLD in which there is hepatitis — inflammation of the liver — and liver cell damage, in addition to fat in the liver. Chronic inflammation and liver cell damage can lead to progressive scarring, cirrhosis and even liver cancer.
We are not sure why some people with NAFLD have NASH while others have simple fatty liver, but we do know that NAFLD is one of the most common causes of liver disease in the United States. It is estimated that between 30 and 40 percent of adults in the United States have NAFLD; about 5 to 10 percent of adults in the United States have NASH.
Although every factor that leads to NASH in an individual is often unknown, it is acknowledged that certain key risk factors exist. Those with obesity (particularly excess belly fat), diabetes mellitus, hypertension, and high cholesterol (or any combination of these) are at increased risk for the deposition of fat and inflammation in the liver.
Diet clearly influences development as well; for example, high-fructose corn syrup (a common sweetener in soft-drinks and fruit juices) promotes development of NASH.
So how do we confront this ongoing pandemic? It should be noted that like many chronic liver conditions, NASH may cause no signs or symptoms.
Evaluation usually starts with a visit to your primary care. Routine annual blood work may reveal liver inflammation, and this warrants further investigation.
Often, simple non-invasive imaging tests such as a liver ultrasound may alert your doctor to the presence of fat in the liver. There really is no such thing as “just a little fatty liver;” and screening tests identifying the presence of liver inflammation or fat should prompt a discussion with a gastroenterologist or liver specialist to fully characterize. Further background information to prepare for such a visit is located here.
While presently there is no FDA approved therapy for NASH, that will change in the coming months to years. The good news is, regardless of what the pipeline produces, the cornerstones of care are already available: implementation of a healthy diet and weight loss.
Losing weight by making healthy food choices (avoiding high fructose corn syrup), reducing portion sizes and being physically active do improve NAFLD and NASH.
Good control of diabetes, hypertension and high cholesterol can protect your liver as well. Even if the condition is recognized a bit later in its course, a solid management plan can be developed with your primary care physician and a gastroenterologist.
I like to think that the liver is the stalwart of the human body; while not always front and center, its proper functioning “behind the scenes” is integral to optimal digestive and metabolic health. As we look forward to a new year and all the hope it brings, please do not forget to show your liver some love!
Editor’s Note: Anil Seetharam MD is a gastroenterologist/hepatologist at Arizona Digestive Health in Scottsdale.