Obesity is an epidemic worldwide and its incidence in both adults and children during the past three decades has increased dramatically. Apart from the well-known connection between obesity and the development of chronic medical conditions such as diabetes, cardiovascular disease, sleep apnea, and cancer, obesity is also a risk factor for liver disease.
Non-Alcoholic Fatty Liver Disease (NAFLD) has become a significant public health concern. Patients with NAFLD could develop Non-Alcoholic Steato-Hepatitis (NASH) which is the active inflammatory component of fatty liver disease. Over time, NASH can further progress to liver failure (cirrhosis) and liver cancer. Estimated to affect up to 20-40% of adults, NAFLD is the most common liver disorder in Western countries. In the USA, fatty liver disease has surpassed alcoholic liver disease and hepatitis C as the most common indication for liver transplantation referrals.
Though a majority of patients with NAFLD will have simple fat accumulation in the liver (steatosis), up to 30% may have NASH and, of those, up to 40% can further progress to cirrhosis and liver cancer.
The diagnosis of NAFLD is often suggested by abnormal liver function tests (LFTs) and/or the presence of hepatic steatosis on imaging studies (such as abdominal ultrasound). Confirmation of its presence can be made with liver biopsy or noninvasive means such as FibroScan. NAFLD generally has no symptoms and the diagnosis is usually suggested when abnormal liver function testing is found on routine labs or perhaps seen incidentally on imaging studies. However, even patients with normal liver function testing can have underlying liver inflammation and patients with more advanced liver disease may be overlooked.
Primary therapy for NAFLD and NASH involves diet modification, exercise and weight loss. Tighter glucose control in diabetics and therapies to reduce cholesterol/triglycerides and normalize thyroid function are also important. Unfortunately, trials of specific potential medical therapies for NAFLD and NASH have been inadequate to this point.
At NVGC, FibroScan technology is available and is becoming the preferred test for diagnosis and monitoring of patients with NAFLD, NASH, and cirrhosis. It is a simple, noninvasive and painless test performed in the office. FibroScan can accurately determine the presence and amount of fat deposition in the liver and further identify the presence of fibrosis and cirrhosis as well.
In addition, NVGC can discuss weight loss management strategies such as a consultation with our nutritionist along with emerging effective medical and endoscopic therapies (ie, ReShape balloon placement).