COMMENTARY

NAFLD Is a Growing Problem

Rowen K. Zetterman, MD

Disclosures

May 18, 2018

A Problem Increasing in Size

Nonalcoholic fatty liver disease (NAFLD) is a condition of hepatic steatosis without significant alcohol intake or another identifiable secondary cause that would result in fat accumulation within hepatocytes. NAFLD is associated with obesity, type 2 diabetes mellitus, and/or hyperlipidemia.[1] Patients with obesity alone in the absence of metabolic syndrome (obesity, type 2 diabetes mellitus, and hyperlipidemia) also have an increased risk of developing NAFLD.[2] NAFLD is a multisystem disease with complications related to obesity and diabetes mellitus, cardiovascular disease, chronic kidney disease, carcinomas (liver, breast, and colon), and polycystic ovary syndrome.[3]

NAFLD is the most common form of liver disease in Western countries.[4] Men are affected more than women.[5] Persons with a "high body mass index in late adolescence" are at risk for advanced liver disease and hepatocellular carcinoma (HCC).[6] The subsequent development of type 2 diabetes mellitus adds even greater risk for development of advanced liver disease.[6]

The current worldwide prevalence of NAFLD is approaching 25%.[7] The prevalence of NAFLD in the United States is increasing, owing to a rising incidence of obesity and type 2 diabetes mellitus.[8,9] Current US projections indicate a 21% increase in NAFLD numbers, leading to a 33.5% overall prevalence by 2030. Coupled with a 63% increase in patients with nonalcoholic steatohepatitis (NASH),[9] there will be a 168% increase in the number of patients with decompensated end-stage liver disease, and a 137% increase in the numbers of patients developing HCC from NAFLD. The growing numbers of NAFLD patients with hepatic fibrosis[8] indicate that end-stage liver disease from NAFLD will probably become the most common reason for liver transplantation in the United States.[10]

A recent publication from the American Association for the Study of Liver Diseases (AASLD) provides guidance for the evaluation and management of patients with NAFLD.[11] This guidance forms the basis for this article where the principles are emphasized in the text. The European Association for the Study of the Liver (EASL) published an additional guideline for NAFLD in 2016.[12]

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