It’s estimated that there are now as many as 100 million Americans living with non-alcoholic fatty liver disease (NAFLD).
“We have 3-year-olds with fatty liver, 16-year-olds with fibrosis, 25-year-olds on the verge of getting a liver transplant.”
These are the staggering statistics with which Sanjiv Chopra, MD, open his talk on NAFLD at Pri-Med Southwest in Houston.
Dr. Chopra, professor of medicine and faculty dean for continuing medical education at Harvard Medical School, and a senior consultant in hepatology at the Beth Israel Deaconess Medical Center in Boston, continued with a barrage of data and anecdotes describing the rise of what was once a largely unknown condition:
Once Unknown, Now Ubiquitous.
“Very little was known about this 25 years ago,” Dr. Chopra said, noting that a 25-year-old textbook of medicine published by a professor at Boston University makes no mention of NAFLD. Dr. Chopra himself co-wrote one of the earliest review articles on the topic, one that appeared in Annals of Internal Medicine in 1997.
As late as 2009, there were just 10 clinical trials on the subject registered in the US, Dr. Chopra said. In 2019, there were 215 trials, he said. “Recently, there were more than 400 clinical trials going on,” he concluded.
While the cause of NAFLD is unknown, risk factors include obesity, high cholesterol, and type 2 diabetes. Most people have no symptoms, but some may experience fatigue, pain, or weight loss. Over time, inflammation and cirrhosis of the liver can occur. While no standard treatment exists, healthcare providers typically work to address the underlying condition, such as obesity. Dr. Chopra described weight loss as the “cornerstone treatment,” and noted that remarkable results can be achieved with bariatric surgery, including reversal of early cirrhosis.
“I also encourage my clinician friends to encourage their patients, even before they are sent to the liver clinic, that if there is a clinical trial suitable for them, please enroll,” Dr. Chopra said. “We need to figure out better treatments for this condition.”
As to dieting to achieve weight loss, Dr. Chopra recommended “any diet that the patient can adhere to, whether it’s the Mediterranean diet, vegetarian, vegan, or a low-carbohydrate diet.” He also noted that he recommends his NAFLD patients take 2,000 to 4,000 IUs of Vitamin D per day and drink 2 to 4 cups of regular coffee.
“Studies show that in NAFLD, the number one factor for least fibrosis is drinking coffee.”
Healthcare Providers Need to Shed Light on the Subject.
Dr. Chopra issued a call to action to the healthcare providers in the audience:
“We shouldn’t be at this stage,” he said. “You and I as healthcare providers are held in high esteem by the general public. We’re trusted. We need to go to schools, to the Lions’ Club, to the Rotary Club and talk about obesity and diabetes.”
He also encouraged healthcare providers to work with the American Liver Foundation in finding opportunities to give talks and to contact local health reporters and provide them with information.
Finally, Dr. Chopra had a word of advice for young people interested in going into hepatology:
“Forget about Hepatitis C. We have a cure. If you want to do work, if you want to do research, do it in the field of non-alcoholic fatty liver disease.”