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The Spectrum of NAFLD: Elevated Liver Tests, Cirrhosis and Liver Cancer

Estimates show that 20 to 30 percent of the U.S. population has a non-alcoholic fatty liver disease or NAFLD. NAFLD is a broad term used to describe a spectrum of liver diseases with evidence of steatosis (or fat) in the liver once other causes of fatty liver, such as medications, alcohol or genetics are ruled out.

In most patients, fat in the liver does not cause any liver-related problems. However, in a small group of patients, NAFLD can lead to end-stage liver disease or cirrhosis.  In addition, a subgroup of those with NAFLD also has liver inflammation, known as non-alcoholic steatohepatitis (NASH), which increases the risk for cirrhosis.

NAFLD is most often seen in patients with obesity, diabetes, elevated cholesterol or elevated triglycerides. Other factors that are seen in association with the disease include polycystic ovary syndrome, hypothyroidism, and obstructive sleep apnea.

“The majority of patients with NAFLD are asymptomatic,” said Sumeet Asrani, MD, a hepatologist on the medical staff at Baylor University Medical Center at Dallas. “NAFLD is commonly diagnosed when elevated liver function tests are seen as part of an annual physical examination. A small percentage of patients can present with complications of the end-stage liver disease such as bleeding, confusion or ascites.”

“The mainstay of treatment for NAFLD is weight loss and exercise and control of the factors, such as diabetes, hypertension, and hyperlipidemia, which may contribute to fatty liver disease,” Dr. Asrani said.  “Studies have shown that if a patient loses 5 percent of body weight, it may be possible to reverse some of the fat in the liver. If one loses 10 percent of body weight, then it may be possible to reverse some of the scarrings in the liver. There is a new medication called obeticholic acid that is currently being studied for the treatment of a certain subset of patients with NAFLD.”

At Baylor Dallas, an experienced team of hepatologists on the medical staff manage patients with the fatty liver disease.  A key part of their evaluation is to make sure the diagnosis of NAFLD is correct and there are no other competing causes. Baylor Dallas is one of the few medical centers in the nation to offer ultrasound- and MR-based hepatic elastography that allows physicians to non-invasively assess whether patients have scarring in their liver without the need for a liver biopsy in a majority of cases.

“Because patients with NAFLD are at increased risk for liver cancer and some may even require liver transplantation, it is important that they are closely followed,” Dr. Asrani said. “Baylor has an extensive evaluation program for management of liver cancer and liver transplantation if the need ever arises.”