The Silent Epidemic: What is Nonalcoholic Fatty Liver Disease (NAFLD)?

  • June 21, 2023
  • By Dr. Jim Cremins, MD

Over the past three decades, chronic liver diseases have had a substantial impact within the medical community and posed as a significant socioeconomic burden to the United States healthcare system. With annual mortality rates increasing to the millions and annual direct medicals costs surpassing $103B, it is no secret that chronic liver diseases need to be addressed.

Coupled with the growing global obesity rates and the silent nature of symptoms, nonalcoholic fatty liver disease has become the fastest growing driver of chronic liver disease and most common indication for liver transplantation in the country.

So, what exactly is nonalcoholic fatty liver disease and how do we begin to combat this disease?

What is NAFLD?

In short, nonalcoholic fatty liver disease (NAFLD) is a term for a range of conditions where excess fat builds up in the liver. This range consists of four phases of progression, which include simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis. Later phases can lead to hepatocellular carcinoma, liver failure and/or the immediate need for a liver transplant.

NAFLD has become the most common chronic liver disease, impacting over 100 million people in the United States alone. Due to the silent nature of the symptoms, these liver diseases often remained undiagnosed only to get progressively worse.

While early-stage NAFLD can cause little harm, the long-term presence of fat within the liver cells can lead to inflammation and scarring of the liver and significant liver dysfunction, making early detection of utmost importance.

NAFLD vs NASH: What’s the Difference?

NASH is a progressed form of NAFLD, and a far more serious inflammatory condition. In addition to fat accumulation in the liver, NASH also includes signs of liver inflammation (hepatitis) and irreversible damage to liver cells. This can lead to irreversible scarring and/or liver cirrhosis while NAFLD usually does not cause liver damage or complications.

It is estimated that 20% of patients with NAFLD will develop NASH, while NASH will progress to cirrhosis in 5-12% of patients. Today, we’re spending $5 billion annually on healthcare costs related to the disease. By 2030, this could rise to $30 billion.

Risk Factors of NAFLD

Given NAFLD is a silent, chronic disease, it is important for both providers and patients to be aware of risk factors that could potentially lead to an early diagnosis. These risk factors include:

  • Obesity
  • Type 2 Diabetes Mellitus (insulin resistance)
  • Hyperlipidemia (elevated cholesterol and triglycerides)
  • Metabolic Syndrome (Hypertension, elevated blood sugar, central obesity, and hyperlipidemia)
  • Underactive Thyroid

There is also possibly a genetic predisposition to developing NAFLD, but further studies are needed to verify.

How to Diagnose Fatty Liver Disease

FibroScan is one of the most effective diagnostic tests to identify fatty liver disease. This noninvasive ultrasound scan measures liver stiffness, hardness, and fatty changes in liver. It is a quick and painless way to confirm or rule out liver damage, without undergoing a liver biopsy.

This testing option is available at some gastroenterology practices and participating hospitals. At ObjectiveHealth, all patients have access to free FibroScan testing at any of our 30+ centers of excellence across the country.

In Pursuit of Finding a Cure

In summary, NAFLD’s spectrum of conditions affecting the liver are mild and clinically insignificant (NAFLD) or complicated, clinically significant, and potentially lethal (NASH). Continuing spreading awareness and furthering education on fatty liver disease is our greatest hope for early diagnosis until we have a cure.

At ObjectiveHealth, we are working through clinical trials in pursuit of an initial therapy for fatty liver disease through our research platform that creates more regular, face-to-face patient care and monitoring. While we actively are searching for a treatment, we promote lifestyle and diet changes that can have an immediate positive impact on those who have been impacted. To learn more, visit www.objective.health.