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Physicians seeing more cases of non-alcoholic fatty liver disease in atypical patients

In typical patients, cases of non-alcoholic fatty liver disease occur around the age of 70, but in recent years, the patient population most impacted by this disease is changing.

Fatty liver disease is a condition where the liver develops fatty cells that reduce its function. This can lead to scarring, also known as cirrhosis. Patients with fatty liver disease generally fall into two categories, fatty liver disease and non-alcoholic fatty liver disease (NAFLD).

Cases of alcoholic fatty liver disease tend to present in patients who drink a large amount of alcohol. NAFLD is a condition where the fatty cells in the liver are not caused by alcohol consumption or Hepatitis.

With cases of non-alcoholic fatty liver disease, the condition usually occurs in patients around the age of 70. But physicians have begun seeing cases of NAFLD in patients rarely affected by this disease.

This rise in cases of NAFLD in atypical patients is due to obesity said Patricia Henry, DO at Carle Foundation Hospital. “Non-alcoholic fatty liver disease is tied to metabolic syndrome.” Metabolic syndrome is the term used to describe conditions like high blood pressure and diabetes spurred on by obesity. “These conditions are caused by obesity which is an epidemic in this country.”

Metabolic syndrome impacts the way your body stores fats and nutrients, and can lead to fatty cells growing in the liver. Diets filled with high fructose corn syrup can increase your chances of developing the conditions associated with metabolic syndrome and NAFLD.

Even still, this condition can be present in people who are thin. In the case of thinner patients, their metabolism is able to handle their dietary choices without significant weight gain but their livers can’t.

Of more concern, the patients developing NAFLD are much younger than ever seen before. NAFLD is the most chronic type of liver disease in the United States, and by 2030, it has the potential to become the most common cause of liver transplant in patients younger than 50, beating out alcoholism and Hepatitis C.

Even in patients as young as children are now affected with non-alcoholic fatty liver disease because of the obesity epidemic. “More children are obese,” says Dr. Henry. “They’re developing fatty livers very early on in life, and because of this, a disease they might not have developed until they are seniors, they are developing as young as age 30.” While it is still rare to see cirrhosis in children, Dr. Henry says that it is no longer rare to see it in young adults.

Because the disease doesn’t present with symptoms or pain, a person with NAFLD may live the rest of their lives without experiencing many health complications, but far more patients with the disease will see negative impacts.

“Some patients may not need treatment while others will develop cirrhosis and can die from it,” Dr. Henry says. Much of the research done on NAFLD suggests it may lower life expectancy by four years.

Many with the disease will only get a diagnosis if their primary care physician screens for indicators during a physical or wellness check. If indicators of the disease are present during an enzyme screening, the patient will then need to visit a hepatologist to perform a liver biopsy or MRI to diagnose NAFLD.

At Carle Health, there is a less invasive diagnostic test is available.

“Carle Foundation Hospital is one of only five or six hospitals in central and southern Illinois who are capable of using a FibroScan, a non-invasive test like an ultrasound, to measure the fat on the liver,” says Dr. Henry. “We also provide patients with a breakdown of the best foods to eat to remove fats and fructose out of their system and exercises they can do to reduce their weight.”

These lifestyle changes can include a Mediterranean diet, intermittent fasting and exercise, and are the best method of reducing the fat on the liver before a patient gets to a point where they need a liver transplant.

“I encourage doctors to think about this disease as a possibility for their younger patients,” says Dr. Henry. “Patients need to be screened when they are tested for diabetes or when cardio testing is performed. Obesity is causing younger and younger patients to develop fatty livers and we need to be the ones to direct them to see a gastroenterologist and hepatologist.”

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