New Technology Could Help Identify Fatty Liver Sooner

According to the American Liver Foundation, approximately 25% of the US population meets the criteria for a spectrum of conditions called non-alcoholic fatty liver disease (NAFLD). This spectrum ranges from benign deposition of fat in the liver to fibrosis (scarring) and cirrhosis (irreversible damage). Of the more than 100 million Americans who have NAFLD, approximately 80% have benign fatty liver and will not progress to the more serious stages of the disease. It is important to identify those who are at risk of progressing to the more serious stages of NAFLD, so an appropriate treatment course can be determined.

Fat deposition in the liver is multifactorial. One major factor is the body having too much fuel, in the form of sugars. These sugars are packaged in the form of fatty molecules called triglycerides and deposited in the liver tissue. As the condition progresses, the fatty deposition is accompanied by significant inflammation and insulin resistance, which is a hallmark of metabolic disease.

The major risk factors for developing NAFLD are obesity, type two diabetes, unmanaged celiac disease, insulin resistance, and elevated lipids. Other potential contributors are an imbalance in the gut microbiome and rapid weight loss. The most common cause of death in those with NAFLD is cardiovascular disease. This is not surprising, given the increased spilling of lipids into the blood and the presence of significant inflammation, which causes damage to the blood vessels.

The progression of NAFLD from fatty deposition to fibrosis, or scarring, is reversible, to a point. Making lifestyle changes like limiting added sugars and refined flours, increasing antioxidants in the diet through a variety of plant foods, and developing a regular exercise routine are some of the most important first steps. As imbalance in the gut microflora has been linked to NAFLD, maintaining healthy digestion and a vibrant microbiome is another target for treatment. Initiating treatments to prevent or manage diabetes or other underlying health conditions as early as possible may help prevent future complications from this disease.

Though it is increasingly common, NAFLD can be difficult to diagnose because a person can be symptom free for many years. In some instances, lab values may be abnormal, but the “gold standard” for diagnosing and evaluating NAFLD is a liver biopsy. As one might imagine, this procedure is invasive and expensive. MRI and ultrasound are also used but each has its own limitations in terms of cost and accuracy.

A newer type of ultrasound, called the FibroScan utilizes a technology called transient elastography. FibroScan is being used more commonly due to its ability to accurately measure fat in the liver and determine the degree of fibrosis. This is hugely important, as it is the best technology for identifying if a person simply has fatty deposition, or if he or she has a progressed stage of NAFLD and needs more aggressive treatment. The FibroScan takes a small amount of time, is noninvasive, and is very affordable.

NAFLD affects one in four Americans and the rates are increasing. Utilizing this minimally invasive and inexpensive technology, the FibroScan, is crucial for early diagnosis and management of this wide-reaching condition.

Dr. Melissa Manda is a naturopathic physician in her second year of residency at Yellowstone Naturopathic Clinic. She practices family medicine and is trained in mind-body medicine and biofeedback.