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A very recent study has found that patients diagnosed with non-alcoholic fatty liver disease and who have an increased level of waist fat, are at greater risk of developing complications to the disease than those who are obese.
Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates around the liver and which may then result in inflammation of the liver. This process can then lead to permanent scarring of the liver, known as cirrhosis, which can then seriously affect this organ's ability to function.

NAFLD is very strongly associated with obesity and the prevalence of this condition is reported to be as high as 80% in these patients. The so-called 'lean' version of this condition is present in 16% of patients with a normal weight and it may cause complications such as high blood pressure, diabetes and premature death.

NAFLD seems to be more common in men than in women up to the age of 60, where the prevalence then equalizes between the genders. The incidence rate of this disease is higher in the Hispanic population, which can be due to the higher rate of obesity and type 2 diabetes in this population group.

The research

A study which was performed by the Policlinico Hospital in Milan, Italy was recently presented by the researchers.

Their findings showed that patients who were diagnosed with 'lean' NAFLD (NAFLD in normal weight patients) and who had increased levels of waist fat, were in fact at greater risk of developing complications than obese patients diagnosed with NAFLD.

The researchers discovered that patients with NAFLD who had a waist circumference of more than 35 inches/89 centimetres in women and more than 40 inches/102 centimetres in men, had an increased risk of developing the following issues:

  • Metabolic syndrome - this is a syndrome characterized by the combination of hypertension, type 2 diabetes and obesity. In turn, these condition can result in problems such as cardiac and/or pulmonary failure, peripheral neuropathy, visual disturbances and sexual dysfunction.
  • Carotid plaques - a buildup of cholesterol deposits and fatty substances within the walls of the arteries. This may result in obstruction of blood flow to the brain and can lead to the development of a stroke.
  • Significant liver fibrosis - the first level of scarring on the liver. When this process continues, then the patient can develop liver cirrhosis and, ultimately, liver failure.

The findings of the research also suggested that the mentioned cardiovascular, metabolic and organ complications of NAFLD, could be better detected by combining body mass index (BMI) data with waist circumference measurements

The clinical significance

This study has shown that body fat which is stored around the patient's waist increases the risks associated with NAFLD more than what obesity does, as what was previously thought.

It has therefore been suggested that further research into why analyzing a patient's waist circumference, and not just their weight, is important in detecting high risk patients diagnosed with NAFLD.

In the meantime, doctors and nurses should be making sure that these high risk patients, diagnosed with NAFLD, are identified through the mentioned measurements and then be referred, followed-up and managed in an appropriate manner. This will decrease the patient's morbidity and mortality risk and will result in a more favourable prognosis, as well as a better quality of life.

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