
18/04/2023
NAFLD: Once a rare disorder, now the most common.
About one-third of the world's population is affected by NAFLD, or non-alcoholic fatty liver disease. Studies show that overweight or obese people, diabetics, middle-aged people, married people, and rural women are more at risk of developing NAFLD than others.
What is Nonalcoholic Fatty Liver Disease (NAFLD)?
Fatty liver disease is the accumulation of excess fat in the liver. Normally, everyone has a little fat in their liver. But people with fatty liver disease have more than 5% of their total liver volume as fat. In the past, fatty liver disease was almost exclusively seen in people who regularly consumed large amounts of alcohol. However, today, many people who do not consume alcohol or consume very little alcohol develop fatty liver disease. That is, not alcohol but other factors play a major role here. For this reason, it is called non-alcoholic fatty liver disease (NAFLD).
The initial stage of non-alcoholic fatty liver disease is non-alcoholic hepatic steatosis, or simply non-alcoholic fatty liver. In some people, the disease stays at this stage, i.e., never progresses. Although they experience various metabolic problems due to excess fat in the liver, there is no permanent damage to their liver.
But, in 25–30% of patients, fatty liver progresses to a more serious condition. Then it is called non-alcoholic steatohepatitis (NASH). In NASH, liver cells swell and tear due to excess fat. As the liver tries to repair these damaged cells, scar tissue forms. This condition is called fibrosis.
About 20% of these NASH cases progress to liver cirrhosis, i.e., 20 out of 100 NASH patients develop liver cirrhosis. And liver cirrhosis is an incurable condition that leads to liver failure at some point.
Again, those in the early stages of the disease are not actually very safe. It turns out that people with non-alcoholic fatty liver have a higher risk of heart disease and type 2 diabetes than others.
The problem is that many NAFLD patients don't even realize they have it. Because, in the initial stage, there are no symptoms. When the disease becomes more complicated, the patient develops symptoms like bloating, loss of appetite, and jaundice.
What causes NAFLD?
There are several factors that can contribute to the development of NAFLD. These include:
Excess calorie intake: Eating more calories than needed can cause excess fat to accumulate in the liver, and fatty liver can occur from any food that provides more calories than the body needs.
Intake of refined carbohydrates: White rice and any food made with flour are refined carbohydrates. Eating more refined carbohydrates than the body can handle will cause the body to store them as fat. This process of making fat from carbohydrates is called de novo lipogenesis (literally, "making new fat"). The liver stores the fat produced in this process for later use. This is what the body does when both carbohydrates and calories become excessive.
One study found that when overweight adults ate 1,000 calories more in carbohydrates than their daily requirement, their liver fat increased by 27% in just three weeks.
Excessive sugar intake: Although sugar is a refined carbohydrate, it is more harmful than other refined carbohydrates. Sugar contains a lot of fructose. It has been shown that people who eat a lot of sugar or foods made with sugar have a faster accumulation of fat in the liver. Some researchers believe that excessive fructose intake is one of the main causes of fat deposits in the liver.
Side effects of certain medications: medications commonly implicated in causing fatty liver include corticosteroids, antidepressants, and antipsychotic medications, and the most common is tamoxifen. In many cases, it is not clear whether fatty liver disease is a direct result of drugs in the liver or is caused by drug-induced weight gain, as is the case with weight gain caused by many antidepressants or antipsychotic drugs.
Saturated Fat: Several studies suggest that eating too much saturated fat can also increase the risk of fatty liver. Saturated fats are generally solid at room temperature. Foods like butter, palm and coconut oil, cheese, and red meat are high in saturated fat.
But there is a question here: studies that blame saturated fat as a contributor to fatty liver have not taken into account the high carbohydrates and high calories that go along with saturated fat. Several recent studies have shown that when people eat low-carb for weight loss, it helps to heal their fatty liver, even if the results are the same for people who eat enough saturated fat at the same time. Therefore, there is room for debate as to whether saturated fat or high-calorie foods are causing fatty liver.
Sedentary lifestyle: Observational studies show that people who spend more time sitting instead of moving have a higher rate of excess fat accumulation in the liver.
However, there are many examples of people who consume a lot of refined carbohydrates and exercise very little but do not develop NAFLD. So who gets it more, actually? There are several factors that increase the likelihood of developing NAFLD. For example:
Insulin resistance: People with diseases related to insulin resistance, such as type 2 diabetes and metabolic syndrome, are at increased risk of NAFLD. Insulin resistance and high levels of insulin in the blood accelerate the accumulation of fat in the liver.
Wide waistline: Carrying too much weight around the middle of the body is strongly correlated with high insulin levels. Even if the BMI is "normal", a larger waist size increases the risk of NAFLD.
Genetics: Some people are more likely to develop NAFLD because they have inherited certain gene variants that increase their risk of the disease. However, more research is needed on this topic.