New method of predicting risk of developing severe liver disease could ensure patients receive early life-saving medical intervention

Using information collected in a liver biopsy study, researchers have developed a method of determining the onset of non-alcoholic steatohepatitis (NASH) through the analysis of lipids, metabolites and clinical markers in blood. The new non-invasive method of predicting the risk of developing a severe liver disease could ensure that patients receive early and potentially life-saving medical intervention before irreversible damage is done. NASH is the most extreme form of non-alcoholic fatty liver disease (NAFLD), a range of conditions caused by a build-up of fat in the liver. With NASH, inflammation of the liver damages the cells, potentially causing scarring and cirrhosis. Currently, the diagnosis of NASH can only be done with a liver biopsy, an invasive and costly procedure. The new research could lead to a simple blood test that could catch the onset of NASH before inflammation damages the liver. Many people with non-alcoholic steatohepatitis do not have symptoms and are not aware they are developing a serious liver problem. As such, diagnosis often comes after irreversible damage is done.

Quicker and less invasive method of diagnosis could mean that more people with non-alcoholic fatty liver disease could be easily tested to determine whether they are progressing to non-alcoholic steatohepatitis, the more severe form of the disease. A healthy liver should contain little or no fat. It’s estimated that around 20 percent of people in the UK have early stages of NAFLD where there are small amounts of fat in their liver. NASH is estimated to affect up to five percent of the UK population and is now considered to be one of the main causes of cirrhosis, a condition where irregular bumps replace the smooth liver tissue, making it harder and decreasing the amount of healthy cells to support normal functions. This can lead to complete liver failure. Common risk factors for both NAFLD and NASH are obesity, lack of physical exercise and insulin resistance. But if detected and managed at an early stage, it’s possible to stop both NAFLD and NASH from getting worse. The new method of NASH diagnosis will undergo further investigation with a view to developing a simple blood test that can be used by clinicians to provide effective medical care for patients at high risk of the disease.

80% of fatty liver disease patients in Korea don't drink alcohol

One in three Koreans suffers from fatty liver disease. Fatty liver disease is a condition that occurs when large amounts of fat accumulate in liver cells. Despite having multiple causes, fatty liver disease is considered to be caused mostly by excessive alcohol intake.

However, latest research shows that 80% of patients with the disease in Korea do not drink alcohol. In fact the number of patients with non-alcoholic fatty liver disease has doubled in the last 6 years.
Experts now say that the biggest factor in causing the disease is carbohydrates.

Compared to people who eat less carbohydrates, men and women who intake a lot of carbohydrates are 1.7 times and 3.8 times more likely to suffer from fatty livers, respectively.

The fatty liver disease is prevalent among Koreans because Korean people tend to eat a lot of carbohydrates. It's important to reduce the intake of other kinds of carbohydrates such as food made of flour and noodles.

Obesity is another factor that can lead to non-alcoholic fatty liver disease.
This explains why fatty liver disease is being observed among many parents in their 40s and 50s and among overweight children as well.
If left unattended, fatty liver disease can develop into fatal diseases such as cirrhosis and even liver cancer.
To prevent this, doctors advise citizens to exercise for at least 10 minutes a day, watch their eating habits and visit the doctor for regular check-ups.

Fatty liver may increase the risk of heart disease

Patients suffering from fatty liver disease is prone to an increased risk of heart disease as well as the mortality rates associated with it, a new study has found.

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common condition in patients with obesity, type 2 diabetes and arterial hypertension -- where high blood pressure in the arteries is persistently elevated.

The findings showed that NAFLD is an independent risk factor for atherosclerosis -- the build-up of fats, cholesterol and other substances in and on the artery walls -- which may lead to the advent of cardiovascular disease (CVD) -- heart diseases -- related deaths.

Evidence indicates that the fatty and inflamed liver expresses several pro-inflammatory and procoagulant factors, as well as genes involved in accelerated atherogenesis. This raises the possibility that the link between NAFLD and cardiovascular mortality might not simply be mediated by shared, underlying, common risk factors, but rather that NAFLD independently contributes to increasing this risk.

In patients with metabolic syndrome health problems like diabetes and stroke at risk for heart disease events, NAFLD contributes to early atherosclerosis and its progression, independent of traditional cardiovascular risk factors.

This indicates that NAFLD is a precursor of metabolic syndrome. It follows that the diagnosis of fatty liver is extremely important and therefore a thorough cardiovascular and metabolic work-up and strict monitoring of CVD or metabolic complications are needed in the clinical management of NAFLD.

Using the Fatty Liver Index (FLI) a well-validated biomarker, researchers observed that fatty liver is associated with thickness in the major blood vessels in the neck -- a pre-atherosclerotic problem that predicts heart disease events.

Thickness in the blood vessels increases proportionally with FLI, and this association is independent of traditional cardiometabolic risk factors -- like diabetes, heart disease or stroke.

Futher, patients with fatty liver were more likely to develop in the plaques resulting in thickness in the blood vessels over time. Fatty liver disease at baseline predicted the occurrence of carotid plaques independent of age, sex, type 2 diabetes, tobacco use, and other heart disease risk factors. Strict monitoring of cardiovascular disease is recommended when managing nonalcoholic fatty liver disease, the researchers suggested.

Large percentage of liver donors in India have fatty liver

Liver transplants in India are facing a strange hurdle — fatty liver. Top surgeons say nearly 50% of livers from live donors and 80% of those from cadavers are rejected because there is excess accumulation of fat in the organ. 

With increasing obesity, diabetes and metabolic syndrome, doctors fear the rate of rejection may go up further. 

A liver that's up to 20% fatty is accepted for donation. When a donor is diagnosed with 20-30% fat in the liver, doctors try to put him or her on special diet and strict exercise regimen to reduce the fat. But those with higher percentage of fat are outrightly rejected. Unlike donors in the western world, Indians who are lean may also have fatty liver. Though no one knows the exact cause of it, scientists blame our genetic predisposition for the condition.

The liver resides in close proximity to intestines. It is thought that non-Caucasians (including Indians) have a different bacterial population that interacts with the immune system and sends signals to the liver which makes us accumulate more fat. 

How does fatty liver affect a transplant? Retrieving a portion of the liver from a person suffering from the condition could put both the donor and the recipient's life at risk. 

In a liver transplant, doctors take out a portion of the liver from the donor and place it in the diseased patient. But if the liver is fatty, the donor may suffer from organ failure due to reduced capacity of the remaining organ to process food. The recipient is also at risk for developing toxicity which is fatal. 

To counter the problem, most transplant centres ask family members to reduce liver fat. Clinical experience shows 10% weight reduction leads to significant reduction in liver fat. For that, doctors suggest rigorous exercise, diet modification including limiting the intake of food items containing complex sugar such as carbonated drinks and medications such as vitamin E. 

Every year, more than 60,000 people die in India due to liver failure. At most, 1,500 lives are saved with liver transplant — the only treatment option available to such patients — due to lack of donors. The irony of the situation is that more people are suffering from liver failure due to fatty liver disease. But the number of people who can donate is also reducing due to the same condition.

Daily dose of sugary drinks pose risk of non-alcoholic fatty liver disease

Making a habit of drinking sugar sweetened drinks on a daily basis can prove harmful for liver, as a new study claims that it increases the risk for non-alcoholic fatty liver disease (NAFLD).

Tufts University (USA) researchers analysed 2,634 self-reported dietary questionnaires from mostly Caucasian middle-aged men and women enrolled in the National Heart Lunch and Blood Institute (NHLBI) Framingham Heart Study's Offspring and Third Generation cohorts.

The sugar-sweetened beverages on the questionnaires included caffeinated- and caffeine-free colas, other carbonated beverages with sugar, fruit punches, lemonade or other non-carbonated fruit drinks. The participants underwent a computed tomography (CT) scan to measure the amount of fat in the liver and the authors of the current study used a previously defined cut-point to identify NAFLD. They saw a higher prevalence of NAFLD among people who reported drinking more than one sugar-sweetened beverage per day compared to people who said they drank no sugar-sweetened beverages. 

The relationships between sugar-sweetened beverages and NAFLD persisted after the authors accounted for age, sex, body mass index (BMI), and dietary and lifestyle factors such as calorie intake, alcohol, and smoking. In contrast, after accounting for these factors the authors found no association between diet cola and NAFLD.

Sugar-sweetened beverages are a major dietary source of fructose, the sugar that is suspected of increasing risk of NAFLD because of how our bodies process it.

The study was published in the Journal of Hepatology. The study added to a growing body of research suggesting that sugar-sweetened beverages may be linked to NAFLD and other

Fatty liver disease epidemic: De-fat experiment could lead to solution that would ease rampant problem

Fatty liver disease may not be well known, but it's epidemic. Caused mainly by a poor diet and a lack of exercise, the condition has now surpassed alcohol as the leading cause of liver disease in Western nations, doctors say.

Many radiologists see fatty liver cases almost every day. Patients often come in for an imaging test for some other reason and they incidentally notice that they have fatty liver.

In places where obesity rates are higher than other regions, up to 40 per cent of the population has fatty liver disease. It's a serious condition because it can lead to much more serious health problems such as cirrhosis, fibrosis or cancer.

Research project

The prevalence of fatty liver disease has prompted a team of doctors in Halifax to begin a research project.

One of the main challenges when it comes to fatty liver disease and transplants is there's a high chance the donor liver will also have the condition.

If we transplant livers that are fatty, the outcomes are poor.

Some of institutes have system that pumps fluid through the liver, through the blood vessels in the liver. To that solution, they add agents that act on short-term lipid metabolism. So they actually help the liver get rid of its fat by itself and flush it through the bile ducts or through the blood system.

Even if doctors can remove the fat of a very severely fatty liver to become mildly fatty that would still allow them to use that liver for transplant purposes.

De-fatting experiments

The biggest challenge will be to identify which agents work best at de-fatting.
This will allow the ability to use more organs, more livers for transplantation and help more people.

Better diagnosis is another aspect of the research. MRI has always been able to detect a fatty liver, but the Halifax Infirmary now has a powerful new MRI to not only show when a liver is fatty, but also reveal what kind of fat is in the liver and how much inflammation there is.

Having both a fatty liver and inflammation is a bad combination. Currently, the only way to properly diagnose a fatty liver is to do a biopsy.

Adapted Langerdorf Apparatus
Scientists have developed a machine they believe will help remove the fat from liver.

It has complications such as infection, pain and bleeding. And also, fatty liver disease is so prevalent that it's not practical to have every single person have a biopsy.

Having a non-invasive way to assess these people would be very helpful not only for diagnosis, but for monitoring the effects of treatment over time.

Early and more accurate diagnoses are important because once a patient finds out he or she has fatty liver disease, they can change their eating habits and begin an exercise regime that may help ease the problem.

Fatty liver disease if not controlled can lead to cancer

Excessive consumption of alcohol and increased prevalence of obesity has made fatty liver disease as serious as hepatitis B and C, say experts.

The liver is the second largest organ in one's body, which is located under the rib cage on the right side. It processes what one eats and drinks and converts it into energy and nutrients that the body can use. The liver also removes harmful substances from the blood. According to experts, non-alcoholic fatty liver disease is now one of the most common causes of chronic liver disease, which could be caused by obesity, eating junk food, lack of exercise, diabetes and high cholesterol.

Alcoholic and NAFL (non-alcoholic fatty liver) disease could lead to cancer. Liver cancer is the third leading cause of cancer-related deaths in the world. If the damage is not controlled at this stage by lifestyle changes, it may progressively lead to liver cirrhosis, requiring a liver transplant.

It has been seen in various studies that nearly 20 percent of the general population suffers from NAFL. This figure increases to up to 80 percent in those who are obese or diabetic. Up to five percent of these can develop progressive disease.

Hepatitis B carriers are there in two to four percent of the general population and hepatitis C is about 1.5 percent. As the incidence of fatty liver increases progressively, patients of fatty liver requiring transplant may soon surpass those of hepatitis B and C.

Fatty liver is the accumulation of fat in the liver cells. Fatty liver may be associated with liver swelling (inflammation) in some patients leading to slow liver cell death, scarring, ultimately causing cirrhosis.

The disease can be diagnosed easily through ultrasound. Patients come either with non-specific pain and lethargy. Ultrasound diagnoses the disease easily. MRI is more specific, final diagnosis and classification is done by a liver biopsy.

While doctors said that the disease is not passed in generations, they pointed out that dietary patterns within families are usually the same.

Getting rid of Fatty Liver Cuts Diabetes Risk

When fatty liver disease is cured, it takes with it a patient's risk of developing diabetes.

In a study in South Korea, patients whose nonalcoholic fatty liver disease (NAFLD) resolved over a 5-year period no longer had an increased risk of incident diabetes. But for those who had worsening NAFLD, the risk of incident diabetes over 5 years was significantly increased.

Even though the study could not address causal relationships, these data strongly suggest that NAFLD severity is associated with a greater risk of diabetes, and attenuation of fatty liver status decreases risk of developing diabetes.

Fatty liver disease has been associated with an increased risk of type 2 diabetes, but it's not clear whether that risk remains elevated when fatty liver resolves.

To assess the hypothesis, researchers in South Korea conducted a retrospective analysis of 13,218 patients who didn't have diabetes at baseline from a Korean occupational cohort. NAFLD was assessed at baseline and after 5 years.

During follow-up, 234 patients developed incident diabetes. NAFLD resolved in 828 patients, developed in 1,640, and progressed from mild to moderate/severe in 324 patients.

Of the 828 patients whose fatty liver disease vanished, only 12 developed incident diabetes. After adjusting for factors including age, sex, glucose, insulin, body mass index (BMI), cholesterol, and others, the researchers found no increased risk of incident diabetes for patients whose fatty liver resolved.

For this group, risk of incident diabetes was similar to that seen in patients who didn't have fatty liver, either at baseline or at follow-up.

On the other hand, patients who developed new NAFLD over the 5-year study period did have an increased risk of incident diabetes.

But risk was highest for patients whose NAFLD worsened over those 5 years, with a "marked" increase in risk of incident diabetes.
The researchers concluded that the data "strongly support the notion that increases or decreases in liver fat influence glucose homeostasis."