Fatty Liver Disease - An Under Recognized Epidemic
Matt Damon recently started in the movie "Contagion". The movie depicts the effects of an epidemic on this country. We witness the dramatic effects of disease on the widespread population. It is easy to recognize disease when we see loved ones acutely ill. Unfortunately, it is much more difficult to see the chronic epidemics that are no less deadly.
Liver disease is often peceived as a problem for those with alcohol abuse or viral hepatitis. While each of these afflictions has implications for the liver, they are overshadowed by nonalcoholic fatty liver disease (NAFLD). NAFLD is a disease spectrum where patients have liver findings that resemble alcohol induced liver injury, but by definition, occur in patients with little or no significant alcohol history. Some patients have simple fat deposition in the liver with little to no long term sequelae. Other patients will develop inflammation over time that can lead to end-stage liver disease (cirrhosis). This entity has become the most common form of liver disease in western nations. Conservative estimates indicate that 20-40% of the population is affected by this under recognized entity. NAFLD is the fastest rising indication for liver transplantation in the United States.
NAFLD is strongly associated with another epidemic is this country - obesity. The CDC reported is 2010 that 31.5% of the adult population in South Carolina is obese. Georgia was not much better with a rate of 29.6%. For a sobering view of the evolution of the obesity epidemic in this country, visit www.cdc.gov/obesity/data/trends . Obesity, type 2 diabetes mellitus, and hyperlipidemia have been labeled the metabolic syndrome. This syndrome is associated with the excessive triglyceride accumulation in the liver that is NAFLD.
Like many chronic illnesses, NAFLD is generally asymptomatic. Some patients may complain of fatigue, malaise or no-specific right upper quadrant abdominal pain. However, most patients are completely unware that they are dealing with underlying liver disease. The journey to diagnosis generally begins with abnormal labwork, often done for completely unrelated reasons. A gastroenterologist / hepatologist will continue the evaluation and expand it to exclude other diseases. Bloodwork and radiographic imaging are usually performed to better ascertain the degree of inflammation and to asses for liver dysfunction. A liver biopsy may recommended to evaluate the liver more thoroughly. NAFLD is a chronic disease, thesefore careful monitoring and partnership with your physician is essential in management.
NAFLD treatment starts with weight loss and physical activity. The goal should be gradual and not rapid weight loss. While sounding simple, we all know how challenging that goal can be. Your healthcare provider can help discuss plans and provide resources to better achieve those goals. A variety of medications have been investigated to treat NAFLD. These include vitamin E, metformin, atorvastatin and pentoxiffylline. Unfortunately, these are few large scale studies. Decisions about medical therapy are individualized and should only be made in conjunction with your physician.
Movies are often an escape from reality. Sometimes movies open our eyes to reality.
Ryan C. Wanamaker. MD
Center for Digestive and Liver Health
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