Are you at risk for fatty liver disease? Many people might be familiar with damage to the liver caused by excessive alcohol intake but are unfamiliar with “non-alcoholic fatty liver disease” (NAFLD). The surprising statistic is that at least 30 percent of U.S. adults and 10 percent of children beyond two years of age have this condition. So, why might having it be of concern, what are the risk factors, and what can you do about it?
The liver is one of the largest organs in the body. It helps us to process food, beverages, and medications, and assists in removing harmful substances from the body. It is also involved in the production of hormones, proteins, and other important functions. NAFLD is a build-up of fat in the liver that is not related to alcohol intake. Storing fat, however, is not one of its intended roles.
For about 30 percent of persons with NAFLD, this can then lead to non-alcoholic steatohepatitis (NASH) – the inflammation stage of the disease. The concern is that over time, it can progress further to scarring in the liver (cirrhosis), reduced liver function, liver failure, liver cancer, and death.
Factors related to NAFLD can also increase the risk of heart disease. Some possible connections are dysfunction in blood vessels, elevated blood lipids, oxidative stress, and systemic inflammation.
Why is the incidence of NAFLD so high? Various health issues appear to be related to this condition, all of which are increasing in prevalence in this country. Included are obesity, Type 2 diabetes, insulin resistance, polycystic ovary syndrome, and metabolic syndrome.
Statistically, at least half of persons with Type 2 diabetes, have some level of NAFLD. The same is true for about 90 percent of persons with a body mass index (BMI) over 35. Other risk factors include high blood cholesterol, sleep apnea, low thyroid levels, weight gain, inactivity, a poor diet, some medications, and genetic factors.
Metabolic syndrome is a collection of risk factors defined as having several of the following – elevated blood glucose, high blood pressure, low HDL (“good cholesterol”), high blood triglycerides, and/or a high waist to hip ratio.
In the case of insulin resistance, there can be an increase in fatty acids present in the blood. These are then deposited in the liver. In addition, the liver produces and stores higher amounts of these fatty acids.
Fatty liver often goes undetected because of a lack of obvious symptoms in some individuals. An ultrasound of the liver is required for diagnosis. Liver enzymes may or may not be abnormal. For this reason, it may be useful to have imaging done of the liver in persons with multiple risk factors for NAFLD even if liver enzymes are normal. A liver biopsy can determine the level of liver damage.
Addressing NAFLD is based on lifestyle changes. It involves reducing the underlying problematic issues that contribute to the disease. Examples would be weight loss, improved eating habits, and increasing physical activity. The good news is that early intervention can slow or reverse the progression of the disease.
When it comes to weight loss, this should be done gradually. It appears that weight loss that is too rapid (>3.5 pounds/week) can actually worsen NAFLD. When weight is lost too quickly, it causes an increased transport of fatty acids into the liver, increased body inflammation, and an accelerated progression of the disease. Instead, the goal should be a moderate steady loss of weight that can be achieved and maintained. Although achieving a body weight within the normal range is the ideal, in persons who are overweight or obese, any amount of weight loss is helpful in slowing the progression of NAFLD.
When it comes to dietary guidelines, a Mediterranean style diet appears to be a wise choice. This means focusing on fruits and vegetables, fish/seafood, lean animal proteins, whole grains, lower fat dairy products, beans/lentils, nuts seeds, and heart-healthy oils (like those in olive oil, avocado, nuts, seeds, etc.).
Besides adding important nutrients, this pattern of eating can assist in lowering inflammation and providing a higher intake of fiber. A good goal for fiber intake is about 25-30 grams a day. This also means limiting refined or highly processed foods, saturated and trans fats, and added sugars.
Until more significant research is available the American Heart Association currently recommends limited intake of tropical oils – palm and coconut. These are both high in saturated fat and it is not yet determined if they are any less problematic than animal sources of saturated fat.
There are no supplements or FDA-approved medications that can directly treat NAFLD, but some may be used to address conditions contributing to the disease. An example would be omega three fatty acids from fish oils which may help to lower elevated triglycerides and counter inflammation.
Increasing physical activity can be extremely helpful. Guidelines suggest getting some form of cardiovascular exercise most days, working up to 30-60 minutes a day. Improving body composition by doing strength building exercises two to three times a week is also recommended.
The noted lifestyle changes that can benefit NAFLD will additionally help to normalize the conditions that contribute to the disease. This is a win-win endpoint for overall health and quality of life.
Pam Stuppy, MS, RD, CSSD, LD is a registered, licensed dietitian with nutrition counseling offices in York, ME and Portsmouth, NH. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is Board Certified as a Specialist in Sports Dietetics. (See www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas).