Fatty Liver: A Lifestyle-Related Epidemic

Sharon Palmer, R.D.

The obesity epidemic has boosted the numbers of a plethora of chronic diseases, from type 2 diabetes to heart disease.

Now health experts have identified an upswing in yet another chronic condition related to obesity and its partner, diabetes: Nonalcoholic fatty liver disease (NAFLD.)

Scientists from the Center for Liver Disease at Inova Fairfax Hospital in Virginia analyzed data from the National Health and Nutrition Examination Surveys (NHANES) from between 1998 and 2008 and found that the incidence of NAFLD doubled, from 5.5 percent to 11 percent. The data was presented at the April 2011 International Congress of the European Association of the Study of the Liver held in Berlin, Germany. If the current rates of obesity and diabetes in the U.S. continue for another two decades, researchers project that NAFLD will increase by 50 percent by 2030.

What's NAFLD?

NAFLD is a condition, unrelated to excessive alcohol intake, that occurs along a spectrum of liver disease. The spectrum begins with NAFLD, an abnormal accumulation of fat that builds up in the liver cells. It can be mild, but in some people NAFLD can take on a more progressive form, called non-alcoholic steatohepatitis (NASH) in which inflammation occurs in the liver tissue. This spectrum of liver disease can potentially lead to chronic liver disease that produces damage in the liver tissue, decreased blood flow, and diminished ability to process nutrients, hormones, drugs, and toxins that can eventually lead to cirrhosis, liver cancer and liver-related death. Swedish researchers found that people with NAFLD have a much higher mortality rate compared with the general population, according to a 2010 study published in Hepatology.

Who's at risk?

The causes of NAFLD are due to a mixture of genes and lifestyle. "There may be some genetic risk factors if you have family members with NAFLD, but this disease seems to be related to obesity, insulin resistance and metabolic syndrome," says Bethany Thayer, M.S., R.D., director of wellness programs and strategies for the Center for Health Promotion and Disease Prevention at Henry Ford Health System in Detroit and national spokesperson for the American Dietetic Association. A 2009 University of California-San Diego study found that family members of children diagnosed with NAFLD should be considered at high risk for the disease and be tested as part of a routine medical examination. The symptoms of NAFLD include pain in the right upper belly area, fatigue, and increased levels of liver enzymes in the blood.

There's no denying the impact that lifestyle can have on your risk for developing NAFLD. The most common risk factors are diabetes and obesity--two-thirds of people who are obese (BMI over 30) have NASH. In addition, NAFLD has been linked with insulin resistance (which occurs when your body's cells don't respond to insulin and glucose levels rise) and metabolic syndrome--a dangerous cluster of factors that includes elevated triglycerides, blood pressure and blood sugar, and decreased HDL ("good") cholesterol levels. Once you develop NAFLD, the most effective method of treatment is through dietary changes and exercise in order to lose weight and keep glucose, blood lipids and blood pressure in check.

Diet Strategies to Battle Non-Alcoholic Fatty Liver Disease

Nutrition expert Bethany Thayer offers the following advice for preventing and treating NAFLD.

Weight management comes first.

If you are overweight or obese, cut back on calories and pump up the physical activity in order to lose weight. Slow, easy weight loss of about one to two pounds per week can be achieved by dropping 500 to 1,000 calories per day. Try to fit in moderate- to high-intensity exercise, such as walking, jogging, biking, or swimming, for 30 minutes, three to five times per week. In addition, engage in moderately intense activities like taking the stairs instead of the elevator, and gardening, as well as strength training of all major muscle groups twice per week.

Eat a healthy diet.

Thayer emphasizes the need to cut back on saturated and trans fats and sodium while urging consumption of fruits, vegetables and whole grains to keep your blood lipid and blood pressure levels in line.

Keep your blood sugar under control.

Because NAFLD is related to diabetes and insulin resistance, it's important to keep your glucose steady by eating regular meals of consistent size throughout the day. Focus on healthy, high-fiber carbs such as whole grains, fruits, and vegetables, and cut back on refined carbs such as white flour and added sugars.

Avoid alcohol.

To protect the liver in general, you should skip the alcohol, as well as avoid taking vitamin and mineral supplements in excess of the daily requirement; use over the counter medications safely, according to package directions and under your health care provider's direction.

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