5 Surprising Things to Know About Fatty Liver Disease

2. Most people with NAFLD don’t have significant liver damage

In about 15 to 20 percent of cases, however, the excess fat in the liver is accompanied by inflammation and damage to the liver’s cells, leading to an aggressive form of the disease called nonalcoholic steatohepatitis (NASH, for short). With NASH, the liver damage is similar to the kind that’s caused by heavy alcohol use. There’s scarring of the liver (cirrhosis), liver cancer or liver failure.

Not surprisingly, people with NASH are five times more likely to die of liver disease than those with NAFLD that hasn’t progressed, according to research published in Clinical Liver Disease. Among people with NAFLD that hasn’t progressed to the far more serious NASH, cardiovascular disease is the leading cause of death “due to the many shared metabolic risk factors,” Chen says. “Liver disease is the second leading cause of death.”

3. You can have NAFLD without knowing it

People in the early stages of NAFLD usually have no symptoms, and routine blood tests may not show anything amiss with the liver, Abdelmalek says. Complicating matters, elevated liver enzymes in the blood, a possible sign of NAFLD, are often dismissed as a side effect of other medications or the result of recent alcohol consumption.

“The disease has no specific symptoms until the very late stages, which occur after decades, so the disease is often undetected unless the patient has abnormal liver tests or an abdominal ultrasound that demonstrates fat,” says Scott Friedman, M.D., chief of liver diseases and dean for therapeutic discovery at the Icahn School of Medicine at Mount Sinai in New York City.

“Physicians caring for patients with type 2 diabetes, hypertension or high blood lipids — especially if these patients are obese — should consider the possibility of underlying NAFLD. Patients should also encourage their physicians to screen for this condition under these circumstances,” he adds.

NAFLD can be diagnosed through standard blood tests for the liver, “combined with imaging that includes either ultrasound or a bedside test that can measure liver stiffness,” Friedman says. This test, known as Fibroscan or transient elastography, is now widely available in most liver specialists’ offices.

4. Women are at greater risk of NAFLD as they age

Although researchers aren’t entirely sure why that is, they think the reason has to do with sex hormones. “Estrogens are protective against severe liver disease in premenopausal women,” Friedman says, echoing the results of a review of more than 60 studies published in the journal Endocrinology. “After menopause, however, the progression of liver disease accelerates and equals that of men the same age.”

That’s not to say that premenopausal women aren’t at risk of NAFLD, cautions Friedman, “especially if multiple risk factors are present.”

5. Weight loss is the best prescription for NAFLD

Yet another reason to get rid of extra weight: Research shows that losing at least 10 percent of body weight through a combination of diet and exercise can reverse NASH. (A Mediterranean-style diet is the only specific plan recommended by a consortium of professional groups for the treatment of NAFLD and NASH.)

“As clichéd as it may sound, nothing beats addressing the metabolic risk factors through diet, exercise and weight loss,” Chen says. “It’s also essential to control diabetes and high cholesterol, with medications if necessary.”

Also key: avoiding alcohol. Although some research suggests that moderate drinking (defined as one drink per day for women and up to two per day for men) may reduce the risk of NASH and cardiovascular disease, studies show that any amount of alcohol can aggravate NAFLD and interfere with the liver’s ability to heal.

Beyond lifestyle changes, there are no treatments for NAFLD, but “given the precipitous rise in prevalence of NAFLD, there has been an intense effort for the past five to 10 years to understand the disease better and uncover targets for treatment,” Friedman explains.

There are currently more than 100 drugs in clinical trials for this condition. And although none have been approved by the Food and Drug Administration, Friedman says, “We’re getting much closer every day.”