Nonalcoholic Liver Disease

Non-alcoholic liver disease (NALD) refers to a range of liver conditions that affect people who consume little to no alcohol. It is characterized by an increase in fat accumulation in the liver without a significant alcohol presence. NALD is associated with Type 2 diabetes, hypertension, and hyperlipidemia.

This disease is present in at least 80% of patients who have a BMI of more than 35. Additionally, it is more common in women who have a waist circumference over 80 cm and in men whose waist circumference is more than 102 cm. Insulin resistance is the central feature of metabolic syndrome. 

Macrophages in fat produce inflammatory enzymes that break down fat in tissue used predominantly by muscle and other tissue. This inhibits sugar utilization resulting in hyperglycemia, leading to elevated insulin levels. As a result, fatty acid production in the body will further increase.

The over-production of fatty acids leads to elevated triglyceride levels with increased liver fat. This will progressively lead to increased fat in the liver and the development of fibrosis and NASH. 

Fibrosis can lead to worsening liver disease and eventually cirrhosis. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in this country. The disease is very common in children 12-18 years old and can also affect young adults and pregnant women.

Studies & Screening Options

In a recent study, the disease was progressive in 23% of children, even those with dietary therapy. Obesity and elevated liver enzymes alone underestimate the presence of NAFLD.  A liver biopsy is accurate but invasive. A Fibro scan, which measures liver stiffness, has limitations but is currently used for screening.

 In the presence of obesity, elevated liver enzymes, or upper abdominal pain, a consultation with a gastroenterologist familiar with this disease is recommended. Multiple drug research trials are currently in progress. If qualified, a referral for a drug trial can easily be done if a patient qualifies. A gastroenterologist can monitor for disease progression and the development of liver cancer.