Cedars-Sinai Blog

Fatty Liver Disease: Know Your Risk

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About one-third of adults have nonalcoholic fatty liver disease (NAFLD), though many won’t know it until the condition is severe.

Early detection can help reverse NAFLD and can spare patients from developing life-threatening health conditions such as cancer and cardiovascular disease.

Here, Cedars-Sinai hepatologist Hirsh Trivedi, MD, and immunology researcher Ekihiro Seki, PhD, share what you need to know about NAFLD risk, how to talk to your doctor and how to approach a diagnosis.

"A lot of people who are at risk have not yet heard of NAFLD," Trivedi said. "It’s a condition that has been overlooked for a long time."

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Hirsh D. Trivedi, MD

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"There’s a very promising future for medications to treat NAFLD."

What Is NAFLD, and Who Is at Risk?

NAFLD is an accumulation of fat in the liver. The condition is associated with a higher body mass index—about 90% of patients with obesity have NAFLD. About 70% of people with Type 2 diabetes also likely have NAFLD.

Studies show that NAFLD is more prevalent in Latino and some Asian populations, who share a genetic predisposition for the condition.

"Until now, we didn’t know too much about NAFLD and ethnicity, but we need to pay more attention to those populations at risk," said Seki, a professor of Biomedical Sciences

When undetected, NAFLD can advance to a more severe condition, nonalcoholic steatohepatitis (NASH), which leads to liver inflammation and scarring, and can turn into cirrhosis—end stage liver disease—which causes permanent damage and can be fatal.

NAFLD also increases the risk of heart disease and stroke—about 25% of deaths associated with NAFLD are caused by cardiovascular disease. New research found that even mild disease, which often goes undetected, can promote the spread of colorectal cancer to the liver. Seki found that patients with fatty liver have elevated levels of a molecule which deters immune cells from attacking cancer. This enables the cancer to spread, greatly reducing the chance of survival.

How to Talk to Your Physician About NAFLD

If you’re concerned that you’re at risk for NAFLD, talk to your primary care physician. Though NASH is generally diagnosed with a liver biopsy, physicians do have reliable, noninvasive methods to screen for early disease.

A scale called the fibrosis-4 (FIB-4) index combines three common blood tests and your age to develop a "score" that predicts the level of fibrosis, or scarring, in the liver.

The American Gastroenterological Association and the American Diabetes Association recommend all Type 2 diabetes patients undergo FIB-4 screening. An abnormal score warrants a referral to a specialist for further evaluation.

While most patients don’t have symptoms during early stages of NAFLD, some experience fatigue, daytime sleepiness and brain fog. If you’re at risk for NAFLD and low energy is interfering with your daily routine, see your doctor and express your concern.

"NAFLD can cause fatigue, so patients are less active, which can cause more weight gain and more fat in the liver, which makes them even more tired," Trivedi said. "Patients can break that vicious cycle by getting screened and treated."

Patients with colorectal cancer should also request NAFLD screening, Seki said. Radiologists and physicians concerned about cancer spread generally look for tumors in the liver but could be more proactive by searching for NAFLD as well, he said.

How to Treat NAFLD

In its early stages, fatty liver can be reversed by reducing the amount of fat in the liver through weight loss. Usually, you need to reduce your body weight by at least 10% to begin to lose fat in the liver. 

Lifestyle interventions such as diet and exercise are the best ways to treat NAFLD. Trivedi encourages patients to stay active even after they plateau in weight loss.

"Exercise itself has been shown to reduce inflammation in the liver, independent of weight loss, and contributes myriad health benefits," he said.

There is no treatment for severe forms of NAFLD, but several drugs in clinical trials show promise, Trivedi said. Some studies seek to determine whether medications such as semaglutide, which treats Type 2 diabetes and obesity, are effective in reducing fatty liver and fibrosis.

A greater understanding of medications for NAFLD and more awareness of the importance of early diagnosis provide a hopeful outlook.

"There’s a very promising future for medications to treat NAFLD," Trivedi said. "A whole host of medications are being studied, and we hope they can make groundbreaking improvements to treat this condition."