There is a silent epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD) in Ireland.
NAFLD patients can develop cirrhosis without alcohol consumption.
Patients with type 2 diabetes, obesity, and high cholesterol are at greater risk of developing NAFLD which, if undiagnosed and left untreated, may lead to cirrhosis of the liver.
Most patients with type 2 diabetes are not aware that they may carry a risk of developing liver disease as a consequence of diabetes due to Nonalcoholic Fatty Liver Disease (NAFLD).
Why should I learn about Non-Alcoholic Fatty Liver Disease?
After assessing more than 400 patients with NAFLD, we discovered that 1 out of 4 patients had advanced fibrosis or cirrhosis. In addition, 1 out of 3 of these patients had type 2 diabetes. We need to raise awareness among the diabetes community.
Professor Suzanne Norris, Consultant Hepatologist, Liver Wellness
The spectrum of Non-Alcoholic Fatty Liver Disease
Facts of Non-Alcoholic Fatty Liver Disease
NAFLD is defined as an excess of fat on the liver in the absence of increased alcohol intake.
Approximately 20% of patients diagnosed with NAFLD will develop fat-related inflammation of the liver, called Non-Alcoholic Steato-Hepatitis (NASH). NASH may lead to liver damage and scarring (fibrosis) and, if untreated over time, may lead to cirrhosis of the liver.
It is a common condition that affects up to 25% of the adult population and has become the most common cause of chronic liver disease in developed countries.
Routine liver blood tests (LFTs) do not differentiate NAFLD from NASH or accurately stage fibrosis (liver scarring).
Several factors increase the risk of developing NAFLD, including type 2 diabetes, being overweight/obese, high blood pressure, high cholesterol and high triglycerides.
NAFLD can be prevented and/or reversed through healthy eating, exercise and weight reduction.
NAFLD often has no symptoms.
How can I be screened for NAFLD?
FibroScan Liver Assessment
A 15 minute non-invasive, pain free liver scan
International Clinical Practice Guidelines recommend that for type 2 diabetes patients, the presence of NAFLD should be screened irrespective of liver enzyme blood tests, since type 2 diabetes patients are at high risk of liver disease progression. The Fibroscan® Liver Assessment has been recommended as a validated noninvasive procedure for the identification of patients at risk of NAFLD. In some cases, a liver biopsy may be required.
FibroScan® Assessments can be accessed by referral through the Public Hospital System and also directly at some Private Hospitals, including the Liver Wellness clinics in Blackrock Clinic and Beacon Hospital.
Frequently Asked Questions About Diabetes Liver Screen
Why do diabetes patients need a liver scan?
There is a silent epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD) in
Ireland and patients with type 2 diabetes, obesity, and high cholesterol are at
greater risk of developing this disease which, if undiagnosed and left untreated,
may lead to cirrhosis of the liver.
International Clinical Practice Guidelines now recommend that screening for
NAFLD should be part of routine work-up in patients with type 2 diabetes, obesity, and metabolic syndrome.
Why is the liver important?
Your liver is a vital organ that performs many essential functions. It is the largest solid organ in the body, and is located under your rib cage on the upper right side. Your liver processes everything you eat, drink, breathe, and absorb through your skin. It turns nutrients into energy your body can use, and removes harmful substances from your blood.
What is Non-Alcoholic Fatty Liver Disease?
Fat can build up in the liver due to alcohol consumption and by increasing body weight. When fat makes up more than 10% of the liver’s weight, it is called Fatty Liver Disease. If the extra fat is not caused by drinking too much alcohol, the disease is called Non-Alcoholic Fatty Liver Disease (NAFLD).
Am I at risk for Non-Alcoholic Fatty Liver Disease?
People with certain medical conditions are at higher risk for developing NAFLD,
• Type 2 Diabetes
• High Cholesterol
• High Blood Pressure
• High Triglycerides
Do many people have Non-Alcoholic Fatty Liver Disease?
Yes, studies indicate that approximately 25% of the adult population in most countries in Europe and the US have NAFLD, and the incidence is increasing in parallel with increasing rates of diabetes and obesity.
In Ireland, approximately 225,000 people have diabetes (mostly type 2 diabetes), and up to 80% of patients with type 2 diabetes have fat in their liver. Two thirds of diabetes patients older than 50 years are estimated to have NAFLD with advanced liver scarring or fibrosis.
What happens if I have Non- Alcoholic Fatty Liver Disease for a long time?
If someone has NAFLD for a long time, the liver can become damaged from scarring of the liver (fibrosis). If this involves all of the liver and becomes
irreversible, it is called cirrhosis. Patients with type 2 diabetes who do not
drink alcohol can still develop cirrhosis because of fat related inflammation and scarring. This sub-type of NAFLD is called NASH, or Non-Alcoholic Steatohepatitis, and has a higher risk for liver scarring and progression to liver failure compared to patients who have simple fat in their liver with no inflammation.
NAFLD and NASH do not always cause cirrhosis; however, over 20–30 years,
cirrhosis can occur. Cirrhosis is a risk factor for liver failure and liver cancer.
What are the symptoms of Non- Alcoholic Fatty Liver Disease?
Like many liver diseases, NAFLD and NASH are “silent” diseases, which means that people who have them often do not feel sick until they have significant liver damage. Because the awareness of the risk of liver disease due to NAFLD in patients with diabetes is low, patients may not be screened for liver problems. Sometimes, NAFLD is diagnosed when tests are done for other reasons (medical insurance, occupational health screen). NAFLD often causes no symptoms. If symptoms do occur, they tend to be non-specific such as fatigue, a dull ache in the upper right abdomen, sleep apnoea, and achy joints.
What tests can be done to check if I have NAFLD?
A liver ultrasound scan is often the first test to diagnose NAFLD but it cannot
detect how much scar tissue (fibrosis) has developed.
Liver blood tests (ALT, AST) may be abnormal in NAFLD patients but research
has shown that up to 80% of patients with NAFLD and liver damage can
have normal liver blood tests. So liver blood tests are not a sensitive test for screening diabetic patients for NAFLD.
A liver biopsy is an accurate test but may be painful.
A FibroScan® assessment is a painless non-invasive alternative to detecting
liver fat and fibrosis (scarring). International Clinical Guidelines
recommended the FibroScan® assessment as a validated non-invasive procedure for the identification of patients at risk of NAFLD.
What are the treatments available for NAFLD?
Weight reduction is the key factor in treating NAFLD. Studies have proven that losing 7–10% body weight reduces liver fat, reduces liver inflammation and liver scarring.
Patients with diabetes and or high cholesterol should control these conditions. Uncontrolled diabetes or high cholesterol can lead to progressive liver disease.