Obesity and Nonalcoholic Fatty Liver Disease (NAFLD)
Nonalcoholic fatty liver disease (NAFLD) is a condition of excess fat accumulation in the liver. It occurs in around half of patients with obesity, diabetes mellitus, and hyperlipidemia. These diseases often occur together, which is recognized as metabolic syndrome. A subset of patients with NAFLD have a more severe form called nonalcoholic steatohepatitis (NASH), which can lead to cirrhosis and liver cancer.
Nonalcoholic Steatohepatitis Detection and Diagnosis
Most patients with NASH have no specific symptoms. The diagnosis is often made through evaluation of abnormal liver tests, findings during imaging of the abdomen (ultrasound, CT scan, MRI), or sometimes at the time of surgery (such as gallbladder surgery) or during weight reduction surgery. Approximately one third of patients who undergo weight reduction surgery have NASH.
Managing Nonalcoholic Steatohepatitis
Diagnosis and recognition of NASH is important so that interventions to reduce the risk of progression can be offered. Current treatment options involve lifestyle interventions, including weight loss for patients who are overweight/obese, dietary modification, and control of any coexisting features of metabolic syndrome such as diabetes or hyperlipidemia. There are currently no FDA approved medications which have been proven to treat and reverse NAFLD/NASH; however, active clinical trials are underway.
At Mount Sinai, our current approach includes dietary counseling to avoid foods containing high fructose corn syrup and trans/saturated fats. Patients may be referred for weight loss counseling and weight reduction surgery. In addition, the Liver Diseases Division at The Mount Sinai Hospital is conducting clinical trials using investigational agents to treat NASH.