COMMENTARY

New Studies Highlight Increasing Global Prevalence of NAFLD/NASH and Its Considerable Toll

William F. Balistreri, MD

Disclosures

January 18, 2017

In This Article

Risk Factors for Obesity and NAFLD/NASH

Meal Timing: A Modifiable Risk Factor

According to a study by Esteban and colleagues,[4] eating breakfast and lunch, and avoiding late-night meals, can help prevent fatty liver disease. This observation is based on the physiologic tenant that hepatic metabolic pathways exhibit typical circadian rhythmicity, paced by an internal clock. Meal timing may be a signal that keeps the liver in phase with the 24-hour day. Thus, circadian misaligned meals may result in a milieu that promotes obesity and liver steatosis/inflammation.

The researchers imply that this may be of especially high relevance today, as a large percentage of people are working late shifts/nights, which may alter normal sleeping and eating patterns and in turn may exert potentially harmful effects on health. They analyzed data from 9015 adults participating in NHANES III, which included a 24-hour dietary recall. The investigators arbitrarily divided a day into four intervals corresponding to meals ingested during the morning (4-10 AM), midday (10 AM-4 PM), evening (4-10 PM), and late night (10 PM-4 AM).

The timing of meals and the temporal distribution of calories, independent of total caloric consumption (specifically skipping meals and relative caloric intake at each specific meal time) were found to have a significant effect on the severity of fatty liver and the presence of significant fibrosis. Participants who "diversified" their caloric consumption, with more meals eaten per day, lowered the odds of severe steatosis and fibrosis by approximately 10% for each additional meal consumed. Consuming a greater percentage of the daily calories in the morning decreased the odds of steatosis by 14%-21%. Conversely, the odds of steatosis were 20% greater when morning and midday meals were skipped or when meals were consumed late in the night (73%). Late eating also increased the probability of developing significant fibrosis (61%). If validated, these findings suggest that simple modifications of eating habits and the timing of meals may reduce the risk for NAFLD and forestall the development of significant fibrosis.

Increased Cirrhosis Risk in First-Degree Relatives of Patients With NAFLD-Related Cirrhosis

The genetic profile of fatty liver disease in twins was recently reported. Investigators found that NAFLD and hepatic fibrosis are heritable traits.[5]

Loomba and colleagues[6] also reported the results of a follow-up study of patients with NAFLD-related cirrhosis and their first-degree relatives, designed to further assess the genetic risk for fibrosis. The prevalence of cirrhosis in first-degree relatives of cirrhotic patients was significantly higher than in a control population (17.9% vs 1.4%), and the odds ratio of cirrhosis in first-degree relatives was 14.9. The risk for cirrhosis remained statistically and clinically significant after adjusting for age, sex, Hispanic ethnicity, BMI, and diabetes. The investigators recommend screening for advanced fibrosis in first-degree relatives of patients with NAFLD-related cirrhosis.

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