Fatty liver disease not associated with alcohol consumption (NAFLD) has a prevalence in Spain of 25 percent. It is even “increasing, because it is an epidemic,” he says. Rocio Aller of the Sourcescientific director of the Institute of Endocrinology and Nutrition of Valladolid (IENVA) and member of the Spanish Association for the Study of the Liver (AEEH), in an interview with Gaceta Médica.
And it is that non-communicable diseases such as fatty liver are –COVID-19 apart– the pandemic of the 21st century. According to the World Health Organization (WHO), as a whole, this type of disease causes 41 million deaths each yearwhich is equivalent to 71 percent of the deaths that occur in the world.
As its name suggests, fatty liver manifests as an accumulation of fat within the same organ. Specifically “more than 5 percent fat”, specifies Rocío Aller. This accumulation of fat can be a simple steatosis or lead to more advanced forms. “May progress to steatohepatitis or liver fibrosiswith a worse prognosis for the patient”, points out the expert.
Likewise, the patient with NAFLD can also develop cirrhosis and liver cancer. “In fact, in the United States this disease is the leading cause of liver transplantation. Meanwhile, in Spain it is the second cause”, says Aller. “Besides, it’s one of the most common causes of hepatocellular carcinomaeven without having cirrhosis”, he adds.
The main risk factors in this disease are metabolic. “NAFLD is more common in people with obesity, type 2 diabetes (DM2), metabolic syndrome, hypertension, dyslipidemia, central obesity…”, lists Aller. But, fundamentally, she is determined by the current lifestyle, with an unhealthy diet, lack of physical exercise and very sedentary habits.
The profile of these patients are middle-aged people, “given that age is a risk factor by having more time to progress the disease ”, continues the specialist.
However, the expert points out, there are also patients who can develop the disease without being overweight. In this case, due to genetic factors or an unhealthy diet. “In the long term, it produces chronic systemic low-grade inflammation in addition to liver injury,” Aller concludes.
For example, higher prevalences are recorded in South American countries and the United States because “there are higher obesity rates and the food is less healthy,” says the specialist. On the other hand, in the Middle East there are fewer obese individuals, but this disease is also manifested because “they have genetic alterations that can predispose to it.”
‘Suspect’ the disease
One of the characteristics that complicates the diagnosis is that it is a silent disease. In the absence of symptoms, NAFLD can progress and, Sometimes, the diagnosis arrives already in the cirrhosis phase.
The detection of the disease occurs when an abnormality in liver function tests (transaminases) is identified in an analysis. “But only 50 percent have this alteration,” warns Aller. For this reason, the work of Primary Care physicians is fundamental: “Prevention is always more important than cure”, he asserts.
Thus, the PC doctor and the hepatologist have the task of “suspecting the disease”. “If there is no suspicion, the diagnosis can be delayed”, says Aller, who specifies that the unhealthy diet and lifestyle of the population at risk can be a warning indicator.
Treatment and prevention
This disease does not have a specific treatment. There are only treatments for risk factors: diabetes, metabolic syndrome, dyslipidemia, etc. And, despite the fact that there are several phase III clinical trials that are investigating drugs, “to date, none have been approved,” says Aller. In his opinion, it is difficult to approach it as it is a multifactorial disease.
However, the way to prevent NAFLD It is clear and it is a key aspect: “Change the type of diet, using one with a Mediterranean pattern (rich in fruits, vegetables, oily fish, olive oil, whole grains, etc.); avoid simple sugars, sugary drinks, fructose or saturated fats; do physical exercise —both aerobic and anaerobic— and avoid a sedentary lifestyle,” she points out.
In the absence of treatment, the diet is very effective: “It has been shown that 10 percent weight loss allows regression in fibrosis, which is the most advanced stage of the disease”, he points out. Likewise, it is important to prevent overweight and obesity from childhood because “30 percent of children suffer from obesity.”
And it is a relatively recent illness due to current eating patterns. “Now our diet is full of processed and ultra-processed foods, which can produce changes in the genome and lead not only to this disease, but also to various types of cancer,” she warns.