Non-alcoholic fatty liver disease dangerous for the cardiovascular system

The Journal of Arteriosclerosis, Thrombosis and Vascular Biology published a statement April 14 on cardiovascular risk in people with non-alcoholic fatty liver disease (NAFLD). Twenty-five percent of adults worldwide have NAFLD. The Mayo Clinic states that it is the most common chronic liver disease in the United States and its numbers appear to be increasing.

NAFLD often goes unnoticed and the results can be as serious as liver disease caused by alcohol consumption. The statement suggests that people should become more aware of the disease and that more screenings should take place. According to the American Heart Association, many heart-healthy lifestyle choices also reduce the likelihood of NAFLD.

Non-alcoholic fatty liver disease

NAFLD occurs when excess fat is stored in liver cells. This buildup of fat cells in the liver increases the risk of heart disease. It is usually found in adults between the ages of 40 and 60, although 10% of children in the United States between the ages of two and nineteen (about six million) have it.

Atherosclerotic cardiovascular disease is the leading cause of death in people with NAFLD. Atherosclerosis is the buildup of fats, cholesterol, and other substances that block blood flow through the arteries because they become restricted. Blood clots can also result. Nonalcoholic steatohepatitis, hepatic cirrhosis, and hepatocellular carcinoma may also occur.

Non-alcoholic steatohepatitis

The most severe form of NAFLD is called nonalcoholic steatohepatitis (NASH), according to the American Liver Foundation. Along with excess fat in the liver, swelling or inflammation occurs, creating hepatitis. Scarring of the liver, known as fibrosis, is also possible. When fibrosis appears, cirrhosis may also develop. When this happens, healthy liver cells are replaced with hard scar tissue. NASH is one of the main causes of cirrhosis of the liver. According to the American Liver Foundation, 25% of people with NASH in the United States develop cirrhosis.

Another danger initiated by NAFLD is hepatocellular carcinoma, a primary type of liver cancer. Cirrhosis caused by hepatitis can lead to this condition.

Risk factors and symptoms

There are common risk factors for NAFLD and NASH and some are more likely indicators of the occurrence of NASH. Among those that relate to both conditions are obesity, diabetes or prediabetes, excessive levels of fats in the blood, and high cholesterol levels. Additionally, a large waist circumference and high blood pressure may indicate risk. Insulin resistance can also increase the likelihood of NAFLD and NASH. Polycystic ovary syndrome, hypothyroidism, and pituitary gland are specific to NAFLD.

Indicators that NASH may occur include those mentioned above as well as obesity with excess body fat concentrated around the waist, obstructive sleep apnea, advanced age, although it appears in children , and being of Hispanic or Asian descent.

There are often no symptoms of NAFLD, and fat in liver cells does not always cause damage. However, if symptoms do appear, they may include fatigue and pain in the upper right part of the abdomen.

Signs of NASH include weight loss, severe itching, the appearance of tiny blood vessels near the surface of the skin, and stomach swelling, also called ascites. If bruising or bleeding starts to happen more easily, or if jaundice around the eyes or on the skin appears, these may also be symptoms. Confusion and slurred speech can also indicate NASH.

Diagnosis and treatment

The Mayo Clinic reports several techniques for diagnosing NAFLD, including blood tests, a variety of imaging methods, and examination of liver tissue. Blood tests include liver function and enzyme tests, hepatitis and hemoglobin A1C tests. Imagine may include magnetic resonance imaging (MRI) or a combination of MRI and sound wave technology called magnetic resonance elastography. Abdominal ultrasounds and computed tomography (CT) scans are also used. Liver tissue is usually examined if other tests are inconclusive.

Reducing stress on the liver by avoiding alcohol, medication monitoring, and hepatitis vaccinations are recommended. Beyond liver health, weight loss and healthy eating with an emphasis on reducing salt and sugar intake will improve or help prevent NAFLD. Starting or increasing exercise is also helpful and should be done with the advice of a doctor. Controlling existing health conditions, including diabetes, high cholesterol, and hypertension, also helps control NAFLD.

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Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Midland Vascular Health Clinics.

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