Nonalcoholic Fatty Liver Disease Underdiagnosed in Adults

NAFLD, atherosclerotic cardiovascular disease (ASCVD) have common risk factors; NAFLD can be considered a risk enhancer for ASCVD

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THURSDAY, April 14, 2022 (HealthDay News) -- More than one in four adults worldwide are thought to have nonalcoholic fatty liver disease (NAFLD), which is often undiagnosed, according to a scientific statement issued by the American Heart Association and published online April 14 in the Atherosclerosis, Thrombosis, and Vascular Biology.

P. Barton Duell, M.D., from the Oregon Health & Science University in Portland, and colleagues reviewed the underlying risk factors and pathophysiology of NAFLD and its associations with atherosclerotic cardiovascular disease (ASCVD).

The authors note that NAFLD occurs in more than 25 percent of individuals worldwide, with rates increasing in association with obesity and metabolic syndrome. Most patients with NAFLD are undiagnosed; due to poor sensitivity and specificity, measurements of aspartate aminotransferase and alanine aminotransferase are not useful for diagnosing NAFLD. Liver biopsy is the gold standard for diagnosis, but it is expensive and has an increased risk for complications. It is difficult to identify those patients with hepatic steatosis who will progress to develop nonalcoholic steatohepatitis (NASH), cirrhosis, or hepatocellular carcinoma; imaging studies are essential for monitoring severity and progression of disease. Genetic factors modulate the risk for NAFLD development and NASH progression. NASH contributes to and is a marker for an increased risk for ASCVD; NAFLD and ASCVD have many common risk factors. When ASCVD risk is assessed, NAFLD can be considered a risk enhancer. For patients with NAFLD, lifestyle intervention is the key therapeutic intervention. Weight loss of 5 to 10 percent of body weight can reverse hepatic steatosis and stabilize or reduce NASH, but this goal can be difficult to achieve.

"The lack of awareness of the high prevalence of NAFLD contributes to underdiagnosis," Duell said in a statement. "Individuals with risk factors for NAFLD warrant more careful screening."

Two authors and one reviewer disclosed financial ties to the pharmaceutical industry.

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