Early in the 21st century, scientists became aware of a serious clinical problem caused by excess fat in the liver which can lead to chronic liver disease such as cirrhosis and liver cancer. This is called “non-alcoholic fatty liver disease” or NAFLD. NAFLD occurs independently of alcohol consumption, which is also a risk factor for serious liver disease. The risk of NAFLD is much higher with obesity and type 2 diabetes. Over the past 5 years, it has also become clear that NAFLD not only affects the liver, but also increases risk of type 2 diabetes, cardiovascular disease, chronic kidney disease, and some other cancers.

Fat in the liver can progress to cirrhosis and cancer

NAFLD is defined by the presence of at least 5% liver fat accumulation and progresses over time. Advanced diseases, including cirrhosis, also raise the risk of liver cancer. People with type 2 diabetes and NAFLD are at markedly higher risk (approximately 20 times the risk) of cancer compared to people without NAFLD. NAFLD occurs in up to 70% of patients with obesity or type 2 diabetes and, importantly, does not cause symptoms until late in the disease course. It is important that doctors know how to best diagnose and monitor NAFLD early in the disease process, identify those patients who might benefit from available treatment options, and recognize those who need specialist help.

Early-stage treatments are available

Fortunately, it is possible to screen for NAFLD with a blood test called a Fibrosis-4 (FIB-4) score and later a liver scan if needed. There are also drug treatments available which include a drug called pioglitazone and also drugs called GLP-1 receptor agonists.

The burden of NAFLD is rising with increasing rates of obesity and type 2 diabetes. As always “an ounce of prevention (of type 2 diabetes and obesity) is worth a pound of cure.”

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