The silent threat: recognising and reversing fatty liver disease
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), creeps up and is one of the fastest-growing lifestyle-related conditions globally and in South Africa. Here’s what you need to know.
MASLD is a condition characterised by fat buildup in the liver. It is closely linked to metabolic syndrome (overweight/obesity, especially belly fat, type 2 diabetes and hypertension),with obesity and type 2 diabetes being the main driving factors. MASLD is exacerbated by alcohol consumption, which further promotes inflammation and scarring.
“Although MASLD is most common in middle age, children and young adults are increasingly affected due to consumption of ultra-processed foods, sugar-sweetened beverages and decreased physical activity,” says Dr Wendy Spearman, Emeritus Professor of Medicine and a consultant hepatologist in the Department of Medicine at the University of Cape Town. “People with MASLD are at increased risk of developing cardiovascular disease, sleep apnoea, hypothyroidism, polycystic ovary syndrome and malignancies such as colorectal cancer.”
What are the symptoms of fatty liver disease?
MASLD often has no symptoms, and most people live with the fat in their livers without suffering liver damage, Dr Spearman says. Some, however, develop metabolic dysfunction-associated steatohepatitis (MASH), and may complain of fatigue, malaise and vague discomfort in the upper right side of the belly. “Apart from an enlarged liver due to fat infiltration of the liver, there is often very little to find on examination until patients develop complications of cirrhosis (long-term scarring and hardening of the liver), when they are at increased risk of liver failure and liver cancer. If you have risk factors for MASLD, you should ask your healthcare professional to screen for MASLD.”
A diagnosis is made from your medical history, with overweight/obesity and diabetes being important risk factors, a physical exam, and tests – blood tests to check for risk of liver scarring (FIB-4), liver function tests and imaging (transient elastography and ultrasound) to detect deposits of fat in the liver. A liver biopsy is seldom required to determine the diagnosis or severity of liver disease, says Dr Spearman. Depending on the FIB-4 score and imaging (transient elastography), your risk of fibrosis and need for referral to specialised care is assessed.
How is fatty liver disease treated?
Management of MASLD is aimed at actively addressing the factors (obesity, diabetes) driving MASLD and always involves lifestyle changes, which can improve and even reverse fat buildup in the liver, Dr Spearman says. Important lifestyle changes include getting down to a healthy weight; eating a balanced diet low in excess calories, refined carbohydrates, saturated fat and trans fats; not having alcohol or sugary drinks; drinking plenty of water; and exercising for at least 30 minutes on most days. Over-the-counter medicines should be limited. Medications that improve control of diabetes, and lower high blood pressure and high cholesterol, are important.
If you have MASH, in addition to the essential lifestyle changes there are medications that can decrease the accumulation of fat in the liver and improve the inflammation and fibrosis seen in MASH, says Dr Spearman. Consulting a liver specialist is important for people with MASH to optimise management.
It is vital to work closely with your healthcare provider, and to tell them before taking any medicines, dietary supplements, vitamins or herbs, as these may harm your liver.
Can you have fatty liver disease if you’re not overweight?
MASLD is associated with obesity, but over the past 20 years researchers have reported an increase of the disease in people with a ‘normal’ or ‘lean’ weight. They may still have high body fat, especially visceral fat deep in the abdomen around vital organs. According to the Global Liver Institute, they may have a worse outcome and faster progression of the disease than patients who are obese. It can be difficult for healthcare professionals to diagnose fatty liver disease in these cases. Imaging techniques and liver function tests can detect it, but measuring your waist circumference may be the best way to assess your risk.
Link: https://globalliver.org/the-quiet-threat-of-fatty-liver-in-lean-individuals/
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