NAFLD

Liver cirrhosis due to Non-Alcoholic Fatty Liver Disease (NAFLD) has increased 6 fold in the last decade and is the 2nd leading indication for liver transplant. In the United States, annual medical costs to treat NAFLD is over 1 billion dollars.

Of the 25% of adults in the United States who have NAFLD 80% are obese and 44% have Type II Diabetes.

In the beginning, symptoms may not seem so bad to put up with, but NAFLD can lead to Non-Alcoholic Steatohepatitis (NASH) which then leads to liver fibrosis & cirrhosis, liver cancer, liver failure, and/or death.

NAFLD is now the most common chronic liver disease affecting 1 in 3 adults in the United States. It is associated with the consumption of soft drinks and meat. Even 1 soda a day can raise the odds of NAFLD by 45%.

Prognosis is poor with very few patients improving over time. Patients frequently have one or more comorbidly like diabetes, cardiovascular disease, high blood pressure, chronic kidney disease, obstructive sleep apnea, dental health issues, and depression.

These patient’s die primarily from cardiovascular disease.

Addressing the issue early on is crucial to preventing future illness and disability.

Affected youth are often young adolescents with fatigue as their only symptom. Typically they have a high BMI, elevated triglycerides, low HDL, and glucose is usually in the normal range.

Diagnosis

It is crucial to first r/o autoimmune hepatitis because treatments are very different.

Ultrasound is NOT a reliable test for diagnosis, as it does not quantify. CT and MRI imaging may also be used.

Alanine aminotransferase (ALT) test is a blood test that checks for liver damage – an elevated level is not diagnostic of NAFLD or NASH, and in contrast, a normal ALT does not rule out NAFLD and does not rule out fibrosis

Elevated Body Mass Index doesn’t tell you anything about body composition;  plotting a child on the US Center for Disease Control (CDC) growth chart can indicate child is lean, while plotting on the World Health Organization growth chart will show the same child as overweight.

Liver biopsy is the definitive diagnosis for NAFLD/NASH, though often it is not required depending on results of medical history and other tests.

What causes NAFLD?

Essesntially NAFLD is caused by multiple hits to the liver from fatty acids, insulin resistance, dietary signals, genetic predisposition, poor nutrition – diet high in fat & fructose – which leads to bacterial imbalance in the intestine or gut.

When we eat animal meat we get cholesterol overload which can lead to increased fat in the liver. The liver then tries to get rid of the excess cholesterol by dumping it back into the bloodstream. Also, when we eat fat we increase the growth of bad bacteria in our gut which increases inflammation and causes a leaky gut. We are still learning about the role of the gut microbiome in progression and or development of NAFLD.

Our body needs cholesterol to function, HOWEVER, our body is capable of making all the cholesterol it needs. When we eat eggs, meat, and dairy in our diet it increases fat in the liver, causes liver cell death & spilling contents into our blood which is indicated by increased liver enzyme blood tests.

The only treatment to improve/prevent NAFLD is lifestyle changes.

  1. Eat whole food plant-based nutrtiion. Avoid sugary and high cholesterol foods such as soda, eggs, meat, and dairy.
  2. Loss of 5% of weight can create 50% loss of fat in liver
  3. Loss of 10% of weight may start reversing NAFLD
  4. Increase physical exercise even if it is a minimal 5 minutes a day