Healthy liver: The serious disease that has no symptoms

Non-alcoholic fatty liver disease is not related to alcohol consumption and is very likely in some population groups. The good news: Diagnosis is very simple and easy.

We have come to associate alcohol consumption with liver disease, but there is a serious disease that is not related to it and in fact has a significant impact on the population. Non-alcoholic fatty liver disease (NAD) is defined as the accumulation of fat in the liver in people who consume little or no alcohol.

The most common liver disease in Western populations

MALNH is the most common chronic hepatopathy in the West, with a recent study putting its prevalence at 25% with the highest prevalence in Middle Eastern countries.

It is related to the modern lifestyle and more specifically to limited physical activity and a diet rich in animal fat. In Greece in a blood donor population the prevalence of MALNH was 17%. Its prevalence increases after the age of 40 years, while after 70 years most cases with the serious consequences of chronic hepatopathy, such as cirrhosis and hepatocellular carcinoma, occur.

Of particular concern is the epidemiological data in paediatric populations with MALNH being found in 53% of obese children, while cases of children under 12 years of age with cirrhosis of the liver or in need of liver transplantation have been recorded.

Given the significant increase in obesity, a rise in the prevalence and severity of MALNH is expected. Various models estimate an increase of 20% of people with simple steatosis and approximately 50-63% of cases of MALNH and cirrhosis by 2030.

The possible causes and effects on the body

Spilios Manolakopoulos (Professor of Pathology - Gastroenterology, Head of the Hepato-Gastroenterology Unit, 2nd Department of Pathology, Ippokratio General Hospital, School of Medicine, University of Athens) and Konstantina Tiniakou (Professor of Pathological Anatomy - Director of Pathological Anatomical Laboratory, Areteion Hospital, School of Medicine, University of Athens) state that MALNH is associated with obesity, diabetes mellitus, hypertension and hypercholesterolemia and is considered by many to be the hepatic manifestation of the metabolic syndrome.

MALNH causes a wide range of liver damage ranging from simple steatosis, i.e. the accumulation of triglycerides in the hepatocytes (stear in ancient Greek means fat), to the development of non-alcoholic steatohepatitis (NSAH) with additional inflammation, hepatocellular damage (swelling) and then fibrosis with scarring of the liver, which can progress in genetically predisposed individuals to cirrhosis.

A serious disease without symptoms

MALNH is an asymptomatic condition and the diagnosis is made on the occasion of a random blood test, which shows an increase in liver enzyme values or an abdominal ultrasound scan, which shows fatty changes in the liver. Specific non-invasive markers can safely highlight which patients have advanced damage with development of fibrosis or even cirrhosis and can be referred to specialised centres.

However, the diagnosis of MASH, the evolutionary form of MALNH, is still based on liver biopsy, which is indicated in selected patients with inconclusive results on non-invasive markers and in cases with suspected coexisting liver disease. It is emphasised that all patients with diabetes mellitus should be screened for MALNH and, conversely, patients with evidence of MALNH should be screened for prediabetes or diabetes. Overweight or obese people or people with central visceral obesity should have a liver ultrasound.

The evolution and treatment of the disease

The course of people with MALNH depends mainly on the severity of liver damage. Simple steatosis does not carry a risk of developing liver complications. In contrast, the presence of advanced fibrosis and cirrhosis is associated with an increased risk of complications and death. To emphasize that cardiovascular events and neoplasms are the leading causes of death in patients with untreated MALNH, therefore successful and aggressive management of associated metabolic factors is essential.

Despite continuous and intensive research efforts, there is no available drug treatment for MALNH and MASH. .

Therefore, weight loss, a Mediterranean-style diet rich in legumes, vegetables and fruit, and aerobic exercise form the basis of its management alongside cardiovascular risk management.