Nonalcoholic fatty liver disease rates are soaring: What to know

The rates of nonalcoholic fatty liver disease — which can lead to life-threatening conditions, including cirrhosis and cancer of the organs — have been soaring over the past three decades, a new study finds.

Hispanic Americans, especially Mexican Americans, are disproportionately affected by the disease, which causes fat to build up to abnormal levels in the liver. Although several white Americans currently have the disease, rates have been increasing rapidly, 133% over three decades in this group — more than twice the rate of increase seen in Mexican Americans, researchers reported Friday at the annual meeting of the Endocrine Society.

Overall, more than a third of the tens of thousands of adult participants in the study developed the condition, more recently referred to as metabolic associated fatty liver disease.

“More and more people are getting extra fat in their livers,” said co-author Dr. Theodore Friedman, an endocrinologist and professor of medicine at both the Charles R. Drew University of Medicine and Science and the UCLA David Geffen School of Medicine.

Certain genes and metabolic disorders — such as obesity, diabetes, pre-diabetes, high blood pressure and high cholesterol — are known to raise the risk of nonalcoholic fatty liver disease (NAFLD), a leading cause of liver transplantation.

Having an apple shape rather than a pear is also linked to the disease, experts say.

Friedman suggests people steer clear of junk and overly processed foods and cut back on carbs. “It’s a disease that develops because people are eating poorly and not exercising,” he said. “I always tell patients to eat more vegetables.”

Can fatty liver disease be treated?

To take a closer look at rates of NAFLD, Friedman and his team turned to data from the National Health and Nutrition Examination Survey. An analysis of data from 32,726 adults who participated in that study revealed that overall, NAFLD rose from 16% in 1988 to 37% in 2018, an increase of 131%.

  • Among Mexican Americans, the rate of NAFLD was 36% in 1988 and rose to 58% in 2018, an increase of 61%.
  • Among African Americans, the rate was 11% in 1988, rising to 25% in 2018, for a 127% increase.
  • Among white Americans, the rate in 1988 was 15%, which rose to 35% in 2018, for a whopping 133% increase.

Most people with fatty liver disease don’t know they have the condition, which is called a “silent disease” because it has few or no symptoms. People who do have symptoms may feel tired or discomfort in the upper right side of the abdomen.

Nonalcoholic fatty liver disease is the most common cause of liver disease in the US, according to the National Institutes of Health.

“Because it’s so common in people with diabetes and obesity, doctors should be looking for it in people with those conditions,” Friedman said.

There’s no medication approved to treat it, but fatty liver disease can be reversed.

“People who exercise and lose a lot of weight can return to normal,” Friedman said.

If NAFLD continues unabated, it can turn into nonalcoholic steatohepatitis (NASH), which leads to cell damage and inflammation of the liver and eventually cirrhosis.

Can weight loss drugs reverse fatty liver disease?

Friedman hopes that his study will alert people with risk factors to the possibility that they might have developed fatty liver disease without knowing it. He noted that the new class of weight loss drugs — Ozempic, Wegovy and other GLP-1 agonists, which also help people with diabetes control their blood sugar — might aid in reversing fatty liver disease brought on by metabolic factors.

“But I think lifestyle modifications are a better choice,” he said.

Gastroenterologist Dr. Meena Bansal, director of the NASH Center of Excellence at the Icahn School of Medicine at Mount Sinai in New York, said the study highlights the increased prevalence among Hispanic people.

“There is a higher prevalence of a genetic mutation that increases the risk for this disease in Hispanic patients,” said Bansal, who was not involved in the new research. “We need to do more about educating the population about their risks.”

It’s important to realize that a genetic predisposition doesn’t mean you will get fatty liver disease, Bansal said. The best way to avoid it is to maintain a healthy diet and exercise regularly, she added.

Dietary trends that started in the late 1980s may help explain the increase in fatty liver disease in all populations, Bansal said. That’s when “they started adding high fructose corn syrup to sodas,” she said, adding that the sweetener stimulates the liver to make it more fat.

Fatty liver disease “is only important if it’s causing inflammation and scarring of the liver,” Bansal said. And one way to know if you’re at risk is to have your doctor calculate your FIB-4 score, she added.

Why being thin may not protect against fatty liver disease

Weight loss can make a big difference, said Dr. Suzanne Sharpton, an assistant professor of medicine in the division of gastroenterology, hepatology and nutrition at the Vanderbilt University Medical Center. Even the most severe form, NASH, “at most stages is reversible with significant weight loss,” she added.

Still, being thin may not completely protect you from NAFLD. Only a small percentage of people with fatty liver disease are thin, but at least one study suggests that thin people with NAFLD are at a greater risk of dying from the condition.

It’s possible that NAFLD in thin people is related to other metabolic issues, said Dr. Lisa Ganjhu, a gastroenterologist and hepatologist at NYU Langone Health.

“You don’t have to be obese,” Ganjhu said, adding that thin people sometimes have high blood cholesterol levels, for example.

The new study “is a big call for action,” said Dr. Sammy Saab, a professor of medicine and surgery at the UCLA David Geffen School of Medicine. “The problem is we don’t have a good treatment now. We need a pharmacologic intervention, a medication that can reverse the liver damage we see.”

It’s not just in the US, Saab said.

“Throughout the world it’s a huge problem,” he added. “Among women it’s the most common reason for liver transplants.”

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