Jules Hutton was taken aback when a routine ultrasound revealed a troublesome accumulation of fat in her liver. “I was completely unaware that non-alcoholic fatty liver disease (NAFLD) even existed,” recalls Jules, a 51-year-old online print designer from Warrington, Cheshire. “The sonographer informed me that NAFLD can progress to cirrhosis and potentially lead to liver failure or cancer. I was both shocked and afraid because I had no symptoms whatsoever.”
Jules, who hardly consumed any alcohol, believed liver disease only resulted from excessive drinking. But the sonographer explained that her weight was the main culprit. Jules, along with her husband Mark, 54, a college tutor, and their two daughters, lived a fairly healthy lifestyle. However, Jules was unaware that even being slightly overweight could contribute to liver damage.
NAFLD, also known as fatty liver, occurs when there is a build-up of fat cells in or on the liver, potentially causing scarring and affecting liver function. Contrary to other forms of liver disease, NAFLD is not associated with alcohol consumption but is primarily linked to obesity. Unfortunately, the prevalence of NAFLD is increasing due to the rising obesity rates in the UK, where 64 percent of the population is now overweight or obese compared to 52.8 percent in the 1990s.
Approximately one in five adults in the UK are now believed to be affected by NAFLD. However, it’s important to note that even individuals with a slim physique can develop this condition, and rapid weight loss can actually increase the risk.
The problem lies in the fact that NAFLD is often not detected early enough for reversible lifestyle changes and dietary adjustments to be effective. As many as four out of five cases go undiagnosed in the early stages because there are no visible symptoms, leaving those affected unaware of the ticking time bomb in their liver. In 20 percent of cases, NAFLD progresses to non-alcoholic steatohepatitis (NASH), a potentially severe condition that can cause significant scarring, cirrhosis, liver failure, and even liver cancer. Shockingly, only around 5 percent of those estimated to have NASH have actually been diagnosed.
Undiagnosed NAFLD poses a particular risk for post-menopausal women, who are now more likely to die from the disease than men, as recent research has revealed. When Jules was diagnosed with NAFLD nearly two years ago, her weight was just slightly above the ‘healthy range’ with a BMI of 26. She had no idea that her few extra pounds could have such a significant impact on her liver.
Interestingly, slim individuals are increasingly being diagnosed with NAFLD. Professor Johanna DiStefano, a geneticist and head of the diabetes and fibrotic disease unit at the Translational Genomics Research Institute, notes that up to 30 percent of NAFLD cases occur in people with a normal weight, with the percentage varying depending on the country. In certain South Asian regions, a BMI of 23 and above, which is considered within the healthy range for other populations, can increase the risk of NAFLD. The precise causes for this phenomenon are not yet fully understood, but it is thought to be a combination of genetics and environmental factors.
Additionally, factors such as diet and the menopause can also contribute to the development and progression of NAFLD. There is evidence to suggest that a high-sugar diet as well as chemicals present in processed foods can play a role in the disease. Furthermore, women who are post-menopausal experience changes in body fat distribution, which can lead to problems such as insulin resistance, liver inflammation, and increased liver scarring.
Rapid weight loss poses another risk factor for NAFLD. The release of fatty acids from visceral fat in large quantities can have a toxic effect on the liver.
Experts believe that the issue lies not only in the quantity of food consumed but also in the quality of our diet. Vanessa Hebditch, director of policy and communications at the British Liver Trust, argues that the significant increase in obesity rates in the UK cannot be solely attributed to a sudden greediness among the population. Rather, it is the result of a societal environment that encourages an unhealthy relationship with food.
In summary, NAFLD is a serious and increasingly prevalent condition associated with obesity that can lead to severe liver damage if left undetected and untreated. It affects both individuals with excess weight and those within the healthy BMI range, and women who are post-menopausal are particularly at risk. Early diagnosis, lifestyle changes, and a healthy diet are essential for preventing the progression of NAFLD and its potentially devastating consequences.
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