A new study has found that rates of nonalcoholic fatty liver disease — which can cause life-threatening conditions including cirrhosis and cancer of the organ — have skyrocketed over the past three decades.
Hispanic Americans, especially Mexican Americans, are disproportionately affected by the disease, which causes abnormal levels of fat to build up in the liver. Although fewer white Americans currently have the disease, the rate is rising rapidly, with this group rising 133% over three decades — more than double the rate of increase seen in Mexican Americans, researchers reported Friday at the Endocrine Society’s annual meeting. told.
Overall, more than a third of the thousands of adult participants who took part in the study developed the condition, which has recently been referred to as metabolic fatty liver disease.
Charles R. “More and more people are having excess fat in their livers,” said co-author Dr. Theodore Friedman, an endocrinologist and professor of medicine at both 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 increase the risk of nonalcoholic fatty liver disease (NAFLD), a major reason for liver transplant.
Experts say that being shaped like an apple rather than a pear is also associated with the disease.
Friedman suggests people stay away from junk food and highly processed foods and cut down 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 the 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 showed that overall, NAFLD increased from 16% in 1988 to 37% in 2018, a 131% increase.
- Among Mexican Americans, the rate of NAFLD was 36% in 1988 and increased to 58% in 2018, an increase of 61%.
- Among African Americans, the rate was 11% in 1988, an increase of 127% to 25% in 2018.
- Among white Americans, the rate rose from 15% in 1988 to 35% in 2018, a whopping 133% increase.
Most people with fatty liver disease don’t know they have the condition, which is called the “silent disease” because it causes little or no symptoms. People who have symptoms may feel fatigue or discomfort in the upper right side of the abdomen.
According to the National Institutes of Health, nonalcoholic fatty liver disease is the most common cause of liver disease in the United States.
“Because it’s so common in people with diabetes and obesity, doctors should be looking for it in people with those conditions,” Freedman said.
There is no drug 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 her study will alert people with risk factors to the possibility that they may have fatty liver disease without knowing it. He said the new class of weight-loss drugs — Ozempic, Vegovy and other GLP-1 agonists, which also help people with diabetes control their blood sugar — may help reverse fatty liver disease brought on by metabolic factors. can do.
“But I think lifestyle modification is a better option,” 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 an increased prevalence among Hispanics.
“Hispanic patients have a higher prevalence of genetic mutations that increase their risk of the disease,” said Bansal, who was not involved in the new research. “We need to do more about educating that population about their risks.”
Bansal said it’s important to realize that a genetic predisposition doesn’t necessarily mean you’ll get fatty liver disease. The best way to avoid this is to maintain a healthy diet and exercise regularly, he added.
Bansal said dietary trends that began in the late 1980s may help explain the increase in fatty liver disease across all populations. That’s when “they started adding high fructose corn syrup to soda,” she said, adding that the sweetener stimulates the liver to make more fat.
“Fatty liver disease” is only significant when it’s causing inflammation and scarring in the liver, Bansal said. He adds that one way to know if you’re at risk is to ask your doctor to calculate your FIB-4 score.
Why being thin may not protect against fatty liver disease
Assistant Professor of Medicine in the Division of Gastroenterology, Hepatology and Nutrition at Vanderbilt University Medical Center, Dr. Losing weight can make a big difference, said Suzanne Sharpton. Even the most severe form, NASH, “is reversible with significant weight loss in most stages,” she said.
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 higher risk of dying from the condition.
It’s possible that NAFLD in thin people is related to other metabolic issues, said Dr. Lisa Ganzhu, a gastroenterologist and hepatologist at NYU Langone Health.
“You don’t have to be obese,” Ganzhu said, adding that thin people sometimes have high blood cholesterol levels, for example.
The new study is “a huge call to action,” said Dr. Sammy Saab, professor of medicine and surgery at the UCLA David Geffen School of Medicine. “The problem is that we don’t have a good cure now. We need a pharmacological intervention, a drug that can reverse the liver damage we see.”
It’s not just in America, Saab said.
“It’s a big problem all over the world,” he said. “In women it is the most common reason for liver transplant.”