According to a new American Heart Association scientific statement published today in the Association’s peer-reviewed journal Arteriosclerosis, Thrombosis, and Vascular Biology, nearly one in every four persons globally has a liver disorder that is a risk factor for heart disease.
Nonalcoholic fatty liver disease (NAFLD) is a condition in which unusually high levels of fat are formed in the liver, leading in inflammation and damage. Given the difficulties in identifying NAFLD, which are outlined in the statement, the prevalence of the disorder is an estimate.
A scientific statement from the American Heart Association is an expert overview of current research that may inform future guidelines. Professional gastroenterology groups have already issued comments on the problem, but they focus on liver toxicity (such as scarring, cirrhosis, and liver cancer) rather than the danger of heart disease. This is the Association’s first NAFLD statement.
“Nonalcoholic fatty liver disease (NAFLD) is a common condition that is often hidden or missed in routine medical care. It is important to know about the condition and treat it early because it is a risk factor for chronic liver damage and cardiovascular disease,” said P. Barton Duell, M.D., FAHA, chair of the statement writing committee and professor of medicine in the Knight Cardiovascular Institute and Division of Endocrinology, Diabetes and Clinical Nutrition at Oregon Health & Science University in Portland, Oregon.
NAFLD is divided into two types: one in which just fat is present in the liver (non-alcoholic fatty liver) and the other in which inflammation and scarring are present (called non-alcoholic steatohepatitis, or NASH).
Because excessive alcohol use can produce comparable fat deposits and liver dysfunction, the term NAFLD is used to distinguish between disease caused by excessive alcohol consumption and disease caused by other factors.
Because NAFLD can go misdiagnosed for years, the statement emphasizes the importance of NAFLD awareness and monitoring, improved screening methods and therapy, and lifestyle changes to help prevent and manage the illness.
Although healthy living can help avert NAFLD in many individuals, some may develop NAFLD despite their best efforts. 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.
P. Barton Duell
NAFLD raises heart disease risk
In persons with NAFLD, heart disease is the major cause of death. Metabolic syndrome (high blood sugar and triglycerides, increased belly fat, and high blood pressure), Type 2 diabetes, impaired glucose tolerance (prediabetes), and obesity are all risk factors for the diseases.
People with NAFLD, on the other hand, have a higher risk of heart disease than people with the same heart disease risk factors but no liver disease.
NAFLD may sometimes be prevented
Maintaining a healthy body weight, exercising regularly, eating a heart-healthy diet, and treating illnesses like Kind 2 diabetes and increased triglycerides (a type of fat) in the blood can all help to prevent NAFLD. Genetic variables influence whether a person develops NAFLD and whether it progresses 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
According to the statement, the majority of persons with NAFLD are undiagnosed, which is a barrier to optimal medical therapy. In the early stages of NAFLD, people often have no symptoms and appear healthy, and regular blood tests may not reveal any liver abnormalities.
Elevated liver enzymes in the blood, a possible indicator of NAFLD, are frequently misdiagnosed as a drug adverse effect or recent alcohol usage. Furthermore, the absence of high liver enzyme values does not rule out the presence of NAFLD or NASH.
According to the statement, the majority of patients with NAFLD go undetected, which makes it difficult to get the best medical care. In the early stages of NAFLD, people often have no symptoms and appear healthy, and regular blood tests may not reveal any abnormalities in the liver.
Elevated liver enzymes in the blood, which might be a symptom of NAFLD, are frequently misdiagnosed as a drug side effect or recent alcohol usage. Furthermore, the absence of high liver enzyme values does not exclude the possibility of NAFLD or NASH.
“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.
The cornerstone of early NAFLD treatment is lifestyle adjustments. Reducing fat intake, restricting simple sugar consumption, and eating more fiber-rich vegetables and whole grains are among the dietary recommendations.
A consortium of professional organizations has suggested a Mediterranean-style diet as the sole specified dietary plan for the treatment of NAFLD and NASH. Even mild alcohol use can accelerate NAFLD and interfere with the liver’s ability to repair, so it’s best to avoid it.
A dietician can assist persons with NAFLD plan and maintain a healthy diet and, if necessary, lose weight. According to the statement, decreasing 10% of one’s body weight significantly reduced liver fat and improved fibrosis, with lower degrees of improvement with at least a 5% weight loss. Even without weight loss, 20-30 minutes of physical activity each day has been shown to reduce liver fat and increase insulin sensitivity.
To treat Type 2 diabetes, lower cholesterol, or lose weight, medications may be required. For certain persons, weight reduction surgery may be beneficial because the resulting, significant weight loss can be an effective NAFLD intervention. A lipid expert, endocrinologist, or gastroenterologist may be consulted for optimal management.
The American Heart Association’s Council on Atherosclerosis, Thrombosis, and Vascular Biology, the Council on Hypertension, the Council on the Kidney in Cardiovascular Disease, the Council on Lifestyle, and Cardiometabolic Health, and the Council on Peripheral Vascular Disease collaborated on this scientific statement.
Scientific statements from the American Heart Association help people learn more about cardiovascular illnesses and strokes and make better health care decisions. Scientific statements summarize what is currently known about a subject and what areas require further investigation.
While scientific statements can help guide the creation of guidelines, they can not offer treatment recommendations. The American Heart Association’s official clinical practice recommendations are found in its guidelines.
