Waist Fat Is More Serious Than Obesity In Non-Alcoholic Fatty Liver Disease

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.

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. 

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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.

Non-Alcoholic Fatty Liver Disease

Definitions

The following are different types of NAFLD:

• Non-alcoholic fatty liver - although fat deposition on the liver isn't normal, it doesn't necessarily cause any harm. In its simplest form, this condition is very common and causes no complications.
• Non-alcoholic steatohepatitis - in a small number of people, the fatty deposits on the liver cause inflammation of the organ. This can cause liver dysfunction and may lead to cirrhosis.
• Non-alcoholic fatty liver disease-associated cirrhosis - Prolonged inflammation leads to cirrhosis which can become severe enough to cause the liver to become dysfunctional, and finally may result in liver failure.

Causes

Certain medications can lead to NAFLD and they can include the following:

• Corticosteroids.
• Tetracyclines such as erythromycin.
• Antiviral drugs such as the nucleoside analogues.
• Methotrexate.
• Tamoxifen.
• Aspirin, as part of Reye's syndrome in children under 12 years of age.
• Amiodarone.

Sucrose in carbonated soft drinks metabolizes to fructose, and this may cause an increase in fat deposition in the abdomen.

Genetic factors also have a major role to play in the development of this disease in Native American men.

Symptoms

NAFLD usually doesn't cause any signs and symptoms, but when it does it can cause the following issues:

• Fatigue.
• Weight loss.
• Dull upper right abdominal pain.
• Mild jaundice may be noticed, but this is rare.

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Risk factors

There are many conditions and diseases which may be associated with this condition, and these may include the following:

• As mentioned, increased waist circumference and/or obesity.
• Increased triglyceride levels.
• High cholesterol levels.
• Type 2 diabetes.
• Metabolic syndrome.
• Polycystic ovary syndrome.
• Sleep apnoea.
• Hypothyroidism.
• Hypopituitarism.

Diagnosis 

Management 

There is no standard protocol for the treatment of NAFLD, but the condition is managed by addressing risk factors which are associated with this condition. This would include incorporating the following suggestions:

• Losing weight - patients should reduce their calorie intake and increase their physical activity to improve weight loss.
• Choosing healthy food choices - the addition of whole grains, fruits and vegetables are suggested.
• Increased physical activity - a combination of 30 minutes of aerobic exercises and weight training, on most days of the week, has been shown to offer great benefits.
• Diabetic control - it's very important that diabetic patients should monitor their glucose levels regularly, that their medication should be taken correctly and that they should follow-up with their doctors in an appropriate manner.
• Lowering cholesterol levels - patients should be controlling high cholesterol levels with medication, diet and exercise.
• Protecting the liver - avoid things that will cause strain on the liver such as alcohol, as well as certain medications.

Doctors may recommend being vaccinated against Hepatitis A and B to help prevent against contracting these viruses which could cause further damage to the liver.