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A common — though commonly misunderstood — liver disease is on the rise, even among people who rarely reach for the bottle.
About 1 in 4 people have what’s called nonalcoholic fatty liver disease (NAFLD), a condition that occurs when abnormal amounts of fat build up in the liver. And because it’s often missed in routine medical screenings, most people with NAFLD don’t even know they have it, according to a new report in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.
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“Nonalcoholic fatty liver disease is typically diagnosed as an incidental finding when patients are noted to have asymptomatic elevation of liver enzymes on routine laboratory tests or features of a fatty liver on abdominal imaging,” says Manal Abdelmalek, M.D., professor of medicine and director of the Hepatobiliary Disease Interest Group in the Division of Gastroenterology & Hepatology at the Mayo Clinic.
Why the uptick in NAFLD? Part of it has to do with the parallel increase in obesity, type 2 diabetes and high cholesterol — all risk factors for NAFLD, says Po-Hung (Victor) Chen, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. Research suggests that up to 75 percent of people who are overweight and more than 90 percent of people with obesity have NAFLD. What’s more, up to 65 percent of people with type 2 diabetes have NAFLD.
And though the name might suggest otherwise, alcohol can also play a role in the progression of NAFLD. “Even modest alcohol use in the presence of these metabolic risk factors [like obesity] can eventually injure the liver,” Chen says. “And alcohol use has increased in the United States, particularly during the pandemic.” A national survey of U.S. adults found that excessive drinking increased by 21 percent during the COVID-19 pandemic.
Here are five surprising things you need to know about NAFLD.
1. You can be a teetotaler and have NAFLD
There are two types of liver disease that are caused by an abnormal buildup of fat in the liver. NAFLD is the one not caused directly by alcohol consumption, even though alcohol use can aggravate it.
And while it’s true that you can live with a fatty liver, it’s also true that doing so raises your risk for type 2 diabetes and cardiovascular disease, both of which are linked to an increased risk for liver disease, Abdelmalek says. “Simple fatty liver does not disturb liver function; however, progressive liver injury and advanced [liver scarring] can impact liver function.”