Jan 10, 2014 — It’s a bold statement to make, but non-alcoholic fatty liver disease (NAFLD) could be the next health epidemic in the United States. Dr. Robin Kim tells you what NAFLD is, who is at risk and why many patients may be unaware of it until it reaches its middle stages. He also talks about early detections and preventions of NAFLD.

Interview

Interviewer: He says it could be the next health epidemic in the United States. Find out what we're talking about coming up next on The Scope.

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Interviewer: Non-alcoholic fatty liver disease could be the next health epidemic in the United States. Dr. Robin Kim, Executive Medical Director of Transplantation at University of Utah. That's a pretty bold statement. The next epidemic.

Dr. Kim: Without being alarmist, we know that obesity in general is the next epidemic. And one thing that people may not talk about is liver disease or liver health.

Interviewer: Explain exactly what's going on. How's my liver getting fat? And what is that doing to my liver?

Dr. Kim: The liver is one of the most sensitive organs to deposit fat. In fact, its function is to deposit different calories in the form of fat and to release it when you need it. However, the liver cannot balance the over deposition of fats. So when that happens, you have the replacement of normal working liver cells with fat deposits.
At some point that results in an injury to the liver. So that overall condition is called N-A-F-L-D, or non-alcoholic fatty liver disease, because in the past many of these patty depositions were thought to be related to alcohol. When in fact, we realized alcohol is becoming less and less of a primary issues for these fat latent livers.

Interviewer: And the main issue is it happens in people who are overweight. Is that correct? Is that an accurate statement?

Dr. Kim: Absolutely. I think the majority of N.A.F.L.D patients within the United States are victims of obesity. So exercise and tolerance, sedentary lifestyles, poor diet or high caloric diets. These are the most common factors for people to suffer from N.A.F.L.D. Finally, there is a genetic predisposition to having these. And we have defined at least two genetic mutations. Not the most common cause of N.A.F.L.D. but still something that we're learning more about.

Interviewer: So from what I understand, this is also a condition that you don't realize you have until your liver fails.

Dr. Kim: When it's obvious it is in a middle phase, where the liver is actually sustaining injury. However, there are ways to preempt that point.

Interviewer: So how do you know if you're damaging your liver? Is there any symptom?

Dr. Kim: The early indicators would be basic lab test. Your primary care provider typically in some regular interval will get labs. And some of those labs will show liver function abnormality or injury. They will then proceed to do imaging. And imaging in the form of a very simple ultrasound, which takes 30 minutes can show changes related to fatty liver disease. This is the best time to be able to detect early disease, because at that point things are reversible.
There is a point in time where that fatty liver disease becomes a different phenomenon called N.A.S.H., which is non-alcoholic steatohepatitis. That means that the liver cells are actually being injured by the fat around them. The spectrum of that process then becomes much more advanced when where you will have the same type of liver scarring that one would see in alcoholic liver disease or hepatitis.

Interviewer: What are some of the things that you can do?

Dr. Kim: Just as we are becoming more and more aware of obesity as a epidemic, if we address obesity, we should be able to address the majority of non-alcoholic fatty liver disease patients. Really is a population-based approach to liver disease by managing obesity and diabetes. We should be able to manage the majority of fatty liver disease patients.

Interviewer: Is that the message? That we just need to be aware of it, and we just need to manage it?

Dr. Kim: That would be the most economical way to manage disease, the most responsible way to manage disease, and actually the most efficacious or effective way to manage fatty liver disease.

Interviewer: Seems pretty simple.

Dr. Kim: It does. It's harder to do than to, and to relay to our patients, but certainly that's the message. As health care professionals, our job is to educate them in a very soft way. Allow them to engage in their own care. I think at some point though, it does take a little more gentle prodding in getting people to understand that, boy, you could feel a whole lot better if some simple things are done.

Interviewer: We're your daily dose of science, conversation and medicine. This is the Scope. University of Utah Health Science radio.