The first statement on non-alcoholic fatty liver disease (NAFLD) issued by the American Heart Association highlights the risk factors for fatty liver disease and its connection to heart health as well as NAFLD diagnosis and treatment options. The statement was published in Arteriosclerosis, Thrombosis, and Vascular Biology.

Globally, one in four people have a liver condition that increases their risk for heart disease. Arising from the accumulation of fat in the liver, NAFLD and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for a growing proportion of advanced liver disease worldwide. As a result of inflammation, NAFLD can lead to the buildup of scar tissue (fibrosis), cirrhosis (advanced scarring) and even liver cancer. While it often has no symptoms at early stages, the effects of NAFLD can be irreversible.

Fatty liver disease, which is associated with obesity and metabolic abnormalities, is also a risk factor for atherosclerotic cardiovascular disease—the main reason for death among people with NAFLD. With no effective approved medical therapies, NAFLD management depends on lifestyle changes such as weight loss and exercise.

“Non-alcoholic fatty liver disease 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,” P. Barton Duell, MD, of the Oregon Health & Science University in Portland and chair of the statement writing committee, said in a press release.

According to the statement, the often-undiagnosed condition necessitates improved access to screening and treatment. Routine blood tests may miss some of the early signs of NAFLD. Sometimes, abnormal liver enzyme levels may be falsely attributed to medications or other causes. Moreover, normal liver function tests can also hide 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.”

Noninvasive tests like liver ultrasound scans are often used to detect NAFLD. But liver biopsy, a more invasive and expensive test, is used to diagnose advanced NAFLD and NASH. People with fatty liver disease may need to seek specialized consultations with endocrinologists and gastroenterologists.

People who are diagnosed with NAFLD must rely on dietary changes and exercise to check disease progression. They should lower their consumption of fat, simple sugars and alcohol while increasing intake of whole grains and other fiber-rich foods. The statement highlights that other professional groups recommend a Mediterranean diet to tackle NAFLD.

“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.

Besides dietary changes, exercising and losing at least 5% of body weight can lead to some improvements in liver health. A 10% weight loss is linked to a greater improvement in liver fat and fibrosis levels. And, irrespective of weight loss, physical activity has been linked to various benefits for the liver.

Click here to read the statement from the American Heart Association.

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