Global Fatty Liver Day: Invisible Signs of NASH/NAFLD

In the field of liver diseases, non-alcoholic fatty liver disease (NAFLD) and its more severe variant, non-alcoholic steatohepatitis (NASH), are gradually emerging as significant global health issues. In the UK alone, there were more than 12,000 lives lost to liver disease in 2021.

On Global Fatty Liver Day on 13^th June, it’s crucial to raise awareness of these conditions, which often remain undetected until they have progressed significantly. Understanding the invisible signs and the dangers of being undiagnosed can prompt timely action and potentially save lives.

Understanding NAFLD and NASH

NAFLD is characterised by the accumulation of excess fat in the liver of individuals who consume little to no alcohol. While NAFLD itself can be relatively benign, it can progress to NASH, a more severe condition marked by liver inflammation and damage. It is estimated that around 5% of the UK population are living with NASH². The condition can further advance to cirrhosis, liver failure, or even liver cancer.

Invisible Signs of NAFLD and NASH

One of the most challenging aspects of NAFLD and NASH is their subtlety. An astonishing 80% of people living with NASH are not diagnosed³. This is because early stages often present no symptoms, causing these conditions to be known as “silent liver diseases.” However, there are several warning signs that, though easy to overlook, can indicate the presence of NAFLD or NASH:

1. Fatigue and Weakness: Chronic fatigue and an overall sense of lethargy are common but non-specific symptoms that can be easily dismissed as results of a busy lifestyle or aging.
2. Mild Upper Abdominal Pain: Discomfort or a dull ache in the upper right side of the abdomen might be mistaken for digestive issues or muscle strain.
3. Unexplained Weight Loss: While often considered a positive change, unexpected weight loss without changes in diet or exercise can be a sign of these conditions.
4. Enlarged Liver (Hepatomegaly): Detectable through physical examination or imaging studies, an enlarged liver can be an indicator of fat accumulation.
5. Skin Manifestations: Symptoms like jaundice (yellowing of the skin and eyes) and dark urine, can appear in advanced stages, but these are often overlooked until the disease is severe.

The Risks of Being Undiagnosed

The insidious nature of NAFLD and NASH means many individuals remain unaware they have a liver problem until significant damage has occurred. Medics estimate that 1 in every 3 people in the UK has early stages of NAFLD where there are small amounts of fat in their liver⁴. A delay in diagnosis can lead to severe health consequences:

1. Progression to Advanced Liver Disease: Without early detection and intervention, NAFLD can progress to NASH, cirrhosis, and ultimately liver failure, necessitating a liver transplant. In 2021, the NHS reported 776 liver transplants taking place in the UK⁵.
2. Cardiovascular Complications: NAFLD and NASH are linked to an increased risk of cardiovascular diseases. Undiagnosed patients are at higher risk of heart attacks, strokes, and related complications.
3. Metabolic Syndrome: NAFLD often coexists with obesity, hypertension and diabetes, components of metabolic syndrome that exacerbate overall health risks. Medics estimate that Non-alcoholic fatty liver disease (NAFLD) affects around 70% of patients with Type 2 Diabetes⁶.
4. Psychological Impact: The lack of awareness and the sudden realisation of a serious health condition can cause significant psychological stress, affecting mental health and quality of life.

Raising Awareness and Taking Action

Global Fatty Liver Day serves as a crucial reminder of the need for increased awareness, early detection, and proactive management of NAFLD and NASH. Regular health check-ups and liver function tests are essential for individuals with risk factors such as obesity, type 2 diabetes, and high blood pressure, to name a few.

Healthcare professionals must prioritise patient education, emphasising the importance of recognising subtle symptoms and seeking timely medical advice.

MAC are looking for people with NASH, or who are overweight with either type 2 diabetes, high blood pressure, high cholesterol or high triglycerides and may be eligible for our NASH clinical trial. You do not need a diagnosis of Non-Alcoholic Steatohepatitis/NASH to register for this trial. If eligible, you may receive up to £2490 and all study related assessments and medications will be provided free of charge.

For more information, visit MAC Clinical Research’s research page.

¹ British Liver Trust – Liver disease in numbers – key facts and statistics

² NHS Inform – Non-alcoholic fatty liver disease (NAFLD)

³ The European Journal of Health Economics – Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis (NASH) in the United Kingdom (UK) in 2018

⁴ NHS Inform – Non-alcoholic fatty liver disease (NAFLD)

⁵ British Liver Trust – New data published on organ donation and transplant services during the pandemic.

⁶ BMJ – Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study