In the last couple years, nonalcoholic fatty liver disease (NAFLD) has become the No. 1 reason U.S. women are added to the liver transplant list and the second-leading cause for all adults, overtaking hepatitis C.
An estimated one in three adults in the U.S. have NAFLD, which is becoming increasingly common in younger patients. We’re seeing more people in their 20s with not only fatty liver, but also significant liver scarring, which indicates a risk for progression to cirrhosis.
Fatty liver disease is exactly what is sounds like – a condition in which there is too much fat in the liver. It is normal to have some fat in the liver, up to approximately 5.5%. In some patients, the amount of liver fat can exceed this level and lead to liver inflammation and injury.
There are two main types of fatty liver, both of which can culminate in cirrhosis of the liver – death of the organ tissue – or liver failure:
1. Alcoholic, caused by drinking too much, even for a short period of time, and
2. Nonalcoholic, caused by factors such as obesity and genetics.
There are currently no drugs approved by the U.S Food and Drug Administration to treat NAFLD. However, UT Southwestern is one of the world’s leading research institutions in liver disease treatment. We are conducting clinical studies to find and improve medication options for NAFLD. We are also developing a multispecialty clinic that brings together providers who treat liver disease and can help manage risk factors such as weight loss and exercise approaches.
As this work continues, patients can collaborate with their doctors on strategies to decrease the risk of NAFLD complications. The first step is understanding your personal risk and what you can do now to change the course of your future health.
Understanding your risk for fatty liver disease
The causes of NAFLD are not entirely known, but we there is evidence that proves it is more common in people who have:
- A family history of liver disease
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Metabolic syndrome or obesity
- Sleep apnea, due to shared risk factors
Genetic factors such as ethnicity also may play a role. In the Dallas Heart Study – an unprecedented multiethnic study of cardiovascular health, including body fat distribution –patients of Hispanic descent were found to be at higher risk for fatty liver disease regardless of weight. Caucasian patients have a lower overall risk than Hispanics, and African-American patients are somewhat protected from having as much fat in the liver. This is largely due to favorable genetics that lower fatty liver risk.
Preventing and treating fatty liver disease
There are currently no recommended screening guidelines for NAFLD due to limitations in long-term data and effectiveness of diagnostics and treatment. The diagnosis of fatty liver is often made through a blood test called a liver function test and imaging studies.
There are also no FDA-approved drugs approved to treat the disease today. However, we hope ongoing research – including studies at UT Southwestern – will lead to approved medications.
In the meantime, our frontline approach to prevention and treatment is managing lifestyle factors. Making a commitment to these types of lifestyle changes not only benefits your liver, but also can prevent other conditions such as heart disease and stroke.
When it comes to diet, what is good for the heart is good for the liver. The more your diet includes lean proteins, whole grains, and fresh fruit and vegetables – and the less, sugar, refined foods, and carbohydrates – the better. Limiting or eliminating alcohol also plays a big role in preventing and treating fatty liver. Your doctor can help you create a nutrition plan.
We recommend that people who are overweight or obese aim for 10% weight loss. Even people who lose 3% to 5% of their body weight show improvement in fatty liver disease. Exercise is also important. Data show that when patients with fatty liver increase their activity level – even if they don’t lose weight – it may help improve their liver health. An obesity expert can discuss your options with you, including medication and potentially bariatric surgery.
Fatty liver disease can lead to more serious conditions, including cirrhosis and liver failure. If it does, treatment options include advanced medication, surgery, and potentially liver transplantation.
Early diagnosis gives people a better chance to limit its progression, or possibly even reverse it. Unfortunately, the symptoms are often silent until it’s advanced, meaning many people living with fatty liver disease don’t know it.
Talk with your doctor about whether you may benefit from a liver function test for fatty liver disease, particularly if you have risk factors. We know there is a stereotype around liver disease: that it’s always caused by excessive alcohol use. It’s important to understand that isn’t always the case.