About 1 in 4 adults has an often-missed liver disorder linked to higher heart disease risk

NAFLD may go undiagnosed for years, thus, the statement emphasizes the need for awareness and monitoring for NAFLD, access to improved screening tools and treatment and highlights the lifestyle changes to help prevent and treat the disorder.

NAFLD raises heart disease risk

Heart disease is the leading cause of death in people with NAFLD. The diseases share many of the same risk factors, including metabolic syndrome (elevated blood sugar and blood triglycerides, increased abdominal fat and high blood pressure); Type 2 diabetes; impaired glucose tolerance (prediabetes); and obesity. However, people with NAFLD are at higher risk of heart disease than people who have the same heart disease risk factors without the liver condition.

NAFLD may sometimes be prevented

NAFLD is often preventable by maintaining a healthy body weight, exercising regularly, eating a heart-healthy foods diet and managing conditions such as Type 2 diabetes and elevated triglycerides (a type of fat) in the blood. Genetic factors also play a role in whether a person develops NAFLD and whether it leads to NASH, cirrhosis or liver cancer.

“Although healthy living can help avert NAFLD in many individuals, some may develop NAFLD despite their best efforts,” Duell said. “At the other end of the spectrum, some individuals may have a genetic makeup that protects them from developing NAFLD despite having obesity, Type 2 diabetes, metabolic syndrome, unhealthy dietary habits or being sedentary.”

NAFLD can go undiagnosed for years

Most people with NAFLD are undiagnosed, creating a barrier to optimal medical management, according to the statement. The initial stages of NAFLD generally have no symptoms and people feel well, and routine blood tests may not show liver abnormalities. Often, elevated liver enzymes in blood, a possible sign of NAFLD, may be misattributed to a side effect of medication or to recent alcohol consumption. In addition, the absence of elevated liver enzyme levels does not rule out NAFLD or NASH.

According to the statement, a specialized ultrasound that measures liver elasticity, fat and stiffness (a result of scarring) in the liver can detect NAFLD. This type of liver scan is a noninvasive way to help diagnose and monitor treatment in NAFLD and NASH, yet it is underused. Liver biopsy is the definitive test for the diagnosis of more advanced stages of NAFLD, however, it is invasive and expensive.

“The lack of awareness of the high prevalence of NAFLD contributes to underdiagnosis,” said Duell. “Individuals with risk factors for NAFLD warrant more careful screening.”

If diagnosed in time, liver damage may be reversible

“Part of the good news about managing NAFLD is that healthy eating, regular exercise and weight loss or avoiding weight gain are all valuable interventions to improve health in most of us, regardless of whether we have NAFLD,” said Duell.

Lifestyle changes are the cornerstone of treatment for early NAFLD. Dietary recommendations include reducing fat intake, limiting the consumption of simple sugars and choosing more fiber-rich vegetables and whole grains. A Mediterranean-style diet is the only specific dietary pattern recommended by a consortium of professional groups for the treatment of NAFLD and NASH. Avoiding alcohol is encouraged since even light alcohol intake can aggravate NAFLD and interfere with the liver’s ability to heal.

Consultation with a dietitian may help people with NAFLD plan and maintain a healthful diet and lose weight, if needed. The statement cites research showing that losing 10% of body weight dramatically reduced liver fat and improved fibrosis, with lower levels of improvement with at least a 5% loss in body weight. Research also supports 20-30 minutes of physical activity per day to decrease liver fat and improve insulin sensitivity even in the absence of weight loss.

Medications may be needed to treat Type 2 diabetes, lower cholesterol or reduce weight. Weight loss surgery may be appropriate for some people because the resulting, marked weight loss can be an effective intervention for NAFLD. Optimal care may also involve consulting with a lipid specialist, endocrinologist or gastroenterologist.

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