Though it receives little media attention, non-alcoholic fatty liver disease (NAFLD) is a serious and growing health threat, especially to those who wrongly assume that drinking little or no alcohol offers protection against harmful liver disorders.

Facts about fatty liver

Dr. Vibhakorn Shusang "Non-alcoholic fatty liver disease refers to a wide spectrum of liver diseases," Dr. Vibhakorn explains, "ranging from fatty liver that can lead to liver failure, to liver scarring, cirrhosis, and liver cancer."

Liver damage in patients with non-alcoholic fatty liver disease is similar to the damage caused by other liver diseases. But most NAFLD patients experience no symptoms, leaving them unaware of their condition unless they undergo routine testing during an annual check-up.

In Thailand and around the world, the prevalence of NAFLD has been increasing in tandem with the growing number of people being diagnosed with metabolic disorders, including diabetes, high blood pressure, and high cholesterol - the leading risk factors for non-alcoholic fatty liver disease. As the body's metabolic rate begins to slow beginning around the age of 45 to 50, those in this age group face a higher risk for metabolic disorders, and in turn, a higher risk for developing NAFLD.
 

There are four stages in the progression of NAFLD:

• Stage 1: In this earliest stage, patients experience an accumulation of liver fat but without the presence of inflammation or scarring of the liver;
• Stage 2: Inflammation in the liver is present; if the inflammation is left untreated and remains present for at least six months, the condition is considered to be chronic;
• Stage 3: The chronic inflammation progresses, causing liver scarring and damage to liver cells;
• Stage 4: In this final stage, the majority of liver cells have been damaged and liver function has deteriorated significantly, which eventually leads to cirrhosis of the liver and liver cancer.

"The progression of non-alcoholic fatty liver disease is very gradual," Dr. Vibhakorn notes. "Once a patient's liver inflammation becomes chronic (i.e. persists longer than six months), it may then take up to 10 years for the inflammation to begin damaging liver tissue - the first stage of NAFLD. Noticeable symptoms like jaundice and abnormal fluid retention typically emerge only during later stages. The final stage is marked by a significant deterioration in liver function that can impact a patient's physical and mental functioning."

While the accumulation of fat in liver cells is usually caused by metabolic problems - obesity, high cholesterol, diabetes, and high blood pressure - certain medications, including steroids and hormone supplements, have also been shown to contribute to liver cell fat build-up.
   

Diagnosing NAFLD

In most cases, fatty liver produces few, if any, symptoms. Patients may experience minor, vague symptoms such as fatigue, nausea, or minor pain below the right side of the rib cage, but these usually don't lead them to suspect they have a liver disorder. "Many patients won't experience any symptoms," Dr. Vibhakorn explains, "while others dismiss them as nothing serious. At this point, if a patient consults his or her doctor and undergoes routine blood testing, test results should reveal inflammation of the liver. This explains why the majority of patients receive their diagnosis during their annual health check-up."

Along with diagnostic blood tests, doctors may also use ultrasound, magnetic resonance imaging (MRI), and liver biopsy testing to diagnose and assess a patient's NAFLD status.
   

Treating NAFLD

Though NAFLD progresses quite slowly from one stage to the next, early intervention is among the most important elements for successful treatment. The main objectives in treating the disease are to reduce fat build-up in the liver and reduce liver inflammation, to prevent further progression of the disease.

"While a blood test can reveal the presence of inflammation, and ultrasound testing is highly accurate in detecting fatty liver," Dr. Vibhakorn explains, "Doctors don't automatically conclude that the fatty liver must be the cause of the inflammation. It is important to rule out other possible causes of liver inflammation, including hepatitis, viral infections, auto-immune disorders, or high levels of iron or copper in the liver. In some cases, a patient's condition can show quick improvement simply by stopping medications or supplements known to cause liver inflammation. In these types of cases, patients still have fatty liver disease but with one less risk factor."

"For patients diagnosed with fatty liver who don't have liver inflammation, medication is usually not necessary," Dr. Vibhakorn says. "The fatty liver condition can be reversed through lifestyle changes - maintaining healthy weight control, regular exercise, better eating habits, and cutting back on sugar and carbohydrate intake. While those changes may sound simple, many of my patients struggle with their weight, and in certain cases I recommend one or more medications to help control risk factors like diabetes, high blood pressure, and high cholesterol. Each patient's situation is unique, so the recommended treatment varies from one patient to another."
   

Healthy habits can lower your risk

With the risk for non- alcoholic fatty liver disease being greatest among patients with metabolic disorders such as diabetes, high cholesterol, and high blood pressure, successfully controlling these disorders can slow or even reverse the progression of NAFLD.
 
Dr. Vibhakorn advises patients to follow these healthier habits to lower their risk for developing NAFLD:

• Follow a weight-loss regimen that's safe and gradual - healthy weight loss is about half a kilogram per week;
• Patients with diabetes or high cholesterol should follow their doctors' recommendations regarding medication, nutrition habits and exercise;
• Limit alcohol consumption, as alcohol can impair liver function;
• Consult your doctor before taking any medications or food supplements, especially those derived from oil, fish oil, or herbal substances;
• Follow your doctor's recommendation for hepatitis vaccinations, follow safer sex guidelines to avoid exposure to sexually-transmitted diseases, and practice good hygiene habits;
• Stick to the recommended schedule for annual check-ups and health screenings. A result outside the normal range of 0 to 40 on the routine blood test measuring AST and ALT enzyme levels is the most common method for detecting the possible presence of NAFLD.

Taking care of your liver is no more difficult than caring for your overall health. But it takes more than avoiding alcohol and controlling your weight to prevent fatty liver disease; controlling cholesterol and monitoring medication and food allergies are also important elements of a successful fatty liver prevention strategy.
 

These factors increase your risk for NAFLD:

• You are overweight and you have fat accumulation around the belly;
• You have difficulty losing weight, even when serious effort is made;
• You have high levels of cholesterol and triglycerides in your blood;
• You have been diagnosed with diabetes;
• You frequently experience fatigue and lack of energy;
• You feel tenderness or pain below the right side of your rib cage;
• You have little appetite and experience frequent nausea.

Did you know . . ?

• Fatty liver is quite prevalent in the U.S.; the U.S. Liver Foundation estimates that 15 to 20 percent of the total U.S. population has fatty liver;
• In Thailand, the incidence of diabetes - a key risk factor for fatty liver disease - among adults over 35 years of age, is about 9.6 percent (source: Thailand Institute of Community-based Healthcare Research and Development);
• More than 50 percent of fatty liver patients exhibit no symptoms during the disease's initial stage (source: Thai Health Promotion Foundation);
• About 90 percent of people with risk factors - those who are obese, have diabetes, high blood pressure and/or high cholesterol - eventually develop fatty liver. About 20 percent suffer liver inflammation, while about 10 percent develop cirrhosis of the liver (source: MedicineNet);
• Overweight patients with fatty liver can reduce the seriousness of their condition by losing about 10 percent of total body weight (source: American Gastroenterological Association).