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Nonalcoholic fatty liver disease is a global epidemic: Are you at risk?

Chances are you’ve never heard of this condition, but you may have it and not even know.
by Kristin Kirkpatrick / / Source: TODAY Contributor

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Nonalcoholic fatty liver disease (NAFLD) is a growing global epidemic. More than one billion people have the condition and it’s risen dramatically with each decade. Experts believe the prevalence of the disease could increase by 50 percent by the year 2030.

Chances are you’ve never heard of the condition, but you may have it and not even know. There's no pill yet to stop it and left untreated, it can develop into nonalcoholic steatohepatitis (NASH), the leading liver disease in the world and on track to become the leading cause of liver transplants.

NAFLD is not tied to alcohol, but primarily to obesity, inactivity and poor lifestyle choices. The early stages are quite treatable and reversible. However, once your liver gets too damaged, it becomes a more dire condition.

Experts are clamoring to answer two primary unknowns: Why do some people get the disease and who is more likely to have it progress to the latter stages?

Here’s how to figure out if this is something you should be concerned about:

Risk factors:

Age — This disease does not blow through your system like a hurricane, rather it grows like a tree. Therefore, age is an important factor in how likely you are to have it progress. That’s why the condition is so concerning in overweight and obese children who have many years to “grow” the tree with a steady diet of sugar and processed food coupled with inactivity.

The longer you have the condition, the more likely it is you may need to be put on a liver transplant list.

Ethnicity — Asian and Hispanic populations tend to get hit the hardest. Some experts believe that in addition to genetic variant factors, triglyceride levels and distribution of fat also play a role in these populations.

Genes — You may be able to partially blame your genes for the development and progression of NAFLD. Studies show a gene called PNPLA3 may play a role.

Your mom’s diet — That’s right: What your mom ate when she carried you could have an impact on your risk of developing a diseased liver. A new animal study found exposure to a high-fat diet in the womb, as well as soon after birth, increased the risk of a more rapid and serious development of the disease later in life. The study found a mom’s high-fat diet actually produced changes in the liver of the fetus that lasted well beyond birth.

Where you store fat — People with apple-shaped figures — who store fat in the central area of the body — are more likely to develop this type of fatty liver disease than those with pear-shaped figures who store fat in the thighs and buttocks.

Gender — Women tend to have a higher incidence of liver disease and are more likely to suffer cardiovascular complications due to the presence of a fatty liver.

3 ways to reduce your risk:

Despite having some risks you can’t change, there are many more you can. A healthy diet and regular exercise should be the main focus.

1. Waist and weight — Several studies show that although a BMI above 30 may be a good gauge of your risk, your waist size may be the best indicator.

Women with a waist size over 35 inches (over 40 inches for men) were at greater risk of metabolic syndrome and development of the condition. Obesity also changes your genes and forms inflammatory pathways that encourage fat infiltration and insulin resistance. Studies show genetic variants such as the PNPLA3 gene mentioned above are more likely to be “turned on” in the presence of an obese environment.

Other conditions related to obesity, like obstructive sleep apnea, can also impact worsening of the condition to more severe forms.

2. Metabolic syndrome — Strong associations have been made with the incidence of type 2 diabetes, high triglycerides, low HDL cholesterol, and high blood pressure with the development and worsening of the disease. Poor diet and inactivity are major risk factors for the development of metabolic syndrome.

To reduce your risk factors for weight, type 2 diabetes and metabolic syndrome, you should focus on small, sustainable goals for weight loss. Losing just 10 percent of your weight can go a long way. One of the best ways to accomplish this is through a low-carb diet. You can also focus on eating more protein at breakfast, which can help to control cravings later in the day.

Finally, some people do well implementing a time-restricted feeding approach by not eating after 5 p.m.

3. Your gut health — This is highly impacted by lifestyle factors, especially diet. One study found having too many bad bugs in the gut increased the risk of developing NAFLD. A diet rich in probiotics and prebiotics, whole grains, fruits and vegetables and low in animal protein may help to produce good bacteria in the gut and may play a role in reducing the risk of obesity and NAFLD.

Adding more fermented foods can help with boosting probiotics in the diet. These include:

  • kombucha
  • miso
  • tempeh
  • sauerkraut

Further, you can help those probiotics by consuming prebiotics found in:

  • bananas
  • leeks
  • onions
  • Jerusalem artichokes
  • dandelion greens
  • chicory root

Make sure your alcohol consumption does not exceed moderate levels: no more than one drink a day if you’re a woman, and no more than two per day if you’re a man.

Being thin may not protect you:

Experts believe a combination of genetics and fat distribution may make some thin individuals contract the condition as well.

Although thin people make up only a small percentage of cases, one study showed they may be more likely to die from the condition than obese individuals. If you’re thin, don’t use it as an excuse to avoid regular exercise and a nutrient-dense diet.

The future of this condition lies directly in our hands. Let’s not wait for a drug to come out on the market to cure it. Let’s do it on our own, by living better and wiser, and by loving the body and the organs that were entrusted to us at birth.

Kristin Kirkpatrick, MS, R.D., is the manager of wellness nutrition services at the Cleveland Clinic Wellness Institute in Cleveland, Ohio. Follow her on Twitter @KristinKirkpat.

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