1 in 5 Americans has non-alcoholic fatty liver disease. What there is to know.

NAFLD is closely linked to obesity and metabolic abnormalities, such as high blood pressure, insulin resistance, and high triglycerides. While rates of risk factors such as obesity continue to rise, including during childhood, approximately 100 million people in the United States expected to have NAFLD by 2030. The condition tends to runs in familiesand Hispanic Americans are disproportionately affected.

Most people are unaware they have NAFLD and will not develop serious complications. But the American Association for the Study of Liver Disease recommends screening for liver scarring in patients with classic risk factors like type II diabetes.

Although there are no approved medications yet, there are a few interventions that can help. The most effective is weight loss and a healthy diet, which can even help reverse NAFLD.

Here are some of the complications that can arise, along with diagnostic and treatment options.

How is fatty liver disease diagnosed

Most patients with NAFLD have no symptoms, although some may experience fatigue or vague abdominal discomfort. Other people are evaluated for NAFLD when their doctor finds they have abnormal liver enzymes during a blood test called a comprehensive metabolic panel.

For example, people with NAFLD often have an elevation of two enzymes produced by the liver, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Another test in which people with NAFLD may have abnormalities is serum ferritina protein in the blood that rises when the liver is inflamed.

After ruling out other causes of liver damage, NAFLD is usually diagnosed with an imaging study like an ultrasound or CT scan, where doctors can see if your liver has a large amount of fat. A liver biopsy is considered the gold standard for making the diagnosis, especially if it’s still unclear what’s going on after imaging tests. Your doctor may also order other tests, such as elastographyto see if you have liver scarring to help stage your disease.

Complications of fatty liver disease

People with fatty liver disease are increased risk of liver cancer and death from cardiovascular disease.

We think that one-fifth of people with NAFLD developing the next stage of the disease, which is inflammation of the liver, known as non-alcoholic steatohepatitis, or NASH.

This inflammation increases the risk of liver scarring. The terminal form of liver scarring is called cirrhosis, one of the most devastating consequences of NASH.

A dysfunctional liver can be life threatening. Due to cirrhosis, patients may experience massive bleeding from ruptured veins in their esophagus, impaired brain function due to accumulation of toxins in the blood, spontaneous infections of their abdomen, and kidney failure.

Cirrhosis is the most common reason for a liver transplant. Although liver transplant results are usually excellent, it involves major surgery and often requires lifelong immunosuppressive drugs to ensure the new liver is not rejected.

Also, the current process for determining who can receive a liver transplant is highly selective and faces ethical dilemmas. Racial and socioeconomic disparities continue to plague the system: For example, Black patients are four times less likely than white patients to receive liver transplants. With thousands of people on the waiting list, many people die every year waiting for an offer for a new liver.

Treatments for fatty liver disease

Treatment for NAFLD is limited, although effective potential therapeutics may be on the horizon. Here are some ways doctors recommend managing NAFLD:

Weightloss: This is the most established recommendation. The goal is to lose a total of 3-5% of body weight (or an even higher percentage of 7-10% of body weight for people with NASH). Studies have found that weight loss through low calorie diet and exercise can help reverse fatty liver disease and scarring. That said, achieving and maintaining weight loss alone is very difficult. If diet and exercise aren’t working after six months, talk to your doctor about other options, such as weight loss medications.

Abstinence from alcohol: Heavy alcohol consumption is associated with the progression of liver disease, and given the uncertain effect of more moderate consumption, total abstinence is generally advised to avoid the risk of disease progression.

Medicine: Although there are still no specific drugs approved by the Food and Drug Administration to treat NAFLD or NASH, some drugs have certain potential benefits in the right patient. These may include supplementation with vitamin E or pioglitazone, which is typically used to treat diabetes. However, more research is needed and the risks and benefits should be discussed with your doctor. Due to the association with diabetes and cardiovascular disease, patients with these comorbidities should be treated accordingly.

Meet the doctor: Trisha S. Pasricha is a gastroenterologist at the Massachusetts General Hospital Center for Neurointestinal Health and a medical journalist.

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