Fatty liver disease already affects more than 115 million patients in the world.
A panel of 22 experts has just published in the ‘European Association for the Study of the Liver’ an article in which it is proposed to change the nomenclature and begin to name the disease known as’ Non-Alcoholic Fatty Liver ‘as’ Fatty Liver Associated with Metabolic Dysfunction.
It is a pathology that has been on the rise in recent years, although it is still unknown among the general population, with its most advanced form, ‘non-alcoholic steatohepatitis’ or ‘NASH’, which affects more than 115 million people worldwide.
As recalled by the National Library of Medicine of the United States, the liver is the largest organ within the body, and is responsible for digesting food, storing energy, as well as eliminating toxins.
Due to this pathology, two types of fat can accumulate: the ‘nonalcoholic fatty liver’ disease, and that produced by the consumption of alcohol itself, also called ‘alcoholic hepatic steatosis’.
In the specific case of non-alcoholic hepatic steatosis, there is inflammation and damage to liver cells, as well as an accumulation of fat (steatosis).
Inflammation and damage to liver cells can cause fibrosis or scarring of the liver. Steatosis can cause cirrhosis or liver cancer.
Until recently, this disease was defined by what it was not. It was not a pathology associated with alcohol consumption and its diagnosis was reached by ruling out other conditions, which led to a delayed diagnosis. Negative implications for a patient’s health were derived from this.
For this reason, this panel of 22 experts in the field has also proposed a series of new positive criteria for its diagnosis, which represents a complete change in the way the disease is approached in its early stages and will foreseeably avoid this delay in diagnosis.
In this regard, having an early diagnosis is essential to start as soon as possible with measures that prevent the progression of the disease, as well as to intensify the follow-up of these patients.
It cannot be ignored that those who suffer from fibrosis or have a progression in their disease have a higher risk of developing cardiovascular events, as well as long-term complications, such as liver cirrhosis and hepatocarcinoma or liver cancer, so it is necessary to follow up on their health.
Right now, a multicenter research study is being carried out in hospitals to conduct a comprehensive assessment of cardiovascular risk that patients may suffer from. Researchers are using non-invasive diagnostic techniques; a scientific work that has not been in danger despite the COVID-19 pandemic, among other points because of the implementation of a safe protocol against COVID-19, as it is a protected space with the most demanding standards of disinfection against the coronavirus pandemic.
Thus, it is important to study this cardiovascular risk, according to specialists, since one of the main implications the disease is the significant rise in fibrosis, that is, that the fatty liver is in an advanced phase of the disease. As a result, this pathology is associated with the development of other pathologies. Data show that after 5 years, there are 14% more patients with this disease who have developed diabetes, and 17% who develop hypertension.
In fact, the study warns that, if these people also suffer from obesity, the annual incidence of developing diabetes and hypertension is approximately 7 cases per 100 people per year. For this reason, following up with these patients and early detection is of special importance. Only in this way will patients avoid worsening their condition with the addition of these comorbidities, which make their management more complex and difficult.
Specifically, researchers cite that the new definition of the pathology is “comprehensive and simple”, as well as independent of other liver diseases, also basing the criteria for its diagnosis on the evidence of hepatic steatosis and the presence of fibrosis in the liver. This can be done either by histological evidence with a biopsy, through imaging techniques, or by blood biomarkers that indicate the accumulation of fat in the liver.
For the detection of steatosis in the liver (fat accumulation), hepatologists point out that ultrasound is the most widely used diagnostic modality, being therefore, the one that is recommended.
The measurement of the controlled attenuation parameter using vibration-controlled transient elastography or FibroScan® (ultrasonographic technique) is the most widely performed in clinical practice, since, in addition to steatosis, it evaluates fibrosis in the liver with a high degree of reliability. We have also been doing this since the start-up a year and a half ago in our hospital of this technology, which has already allowed them to serve more than 700 patients.
Lastly, and for the diagnosis itself, the 22 experts on the panel indicate that the presence of at least one of these three criteria will be necessary: obesity or overweight, type 2 diabetes mellitus, or evidence of metabolic dysregulation.
Until now, this pathology was defined as the presence of steatosis (accumulation of fat) in more than 5% of hepatocytes, and in the absence of significant or recent alcohol consumption, and other known causes of liver disease. With these new criteria, it will be possible to make a diagnosis regardless of alcohol consumption or other concomitant liver diseases.