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 Non-alcoholic fatty liver disease (NAFLD) is the build-up of extra
fat in liver cells that is not caused by drinking alcohol. It's the
most common cause of liver disease in the U.S., the study team
writes in the Journal of Clinical Investigation.
The more severe form of NAFLD, non-alcoholic steatohepatitis (NASH),
tends to develop in people who are overweight or obese or who have
diabetes, high cholesterol or high triglycerides, according to the
American Liver Foundation.
With NAFLD, the liver may swell and develop scarring, known as
fibrosis, or cirrhosis in its more advanced stages. NASH often leads
to more serious liver diseases, including liver cancer. About a
quarter of people with NASH have cirrhosis.
Past research has suggested that NAFLD can run in families, but it
wasn’t known if family members are also prone to developing fibrosis
and more serious liver diseases.
“My goal is to change practice to develop screening guidelines for
who are the patients who are at high risk for developing cirrhosis
and should we be screening them,” said senior study author Dr. Rohit
Loomba of the NAFLD Research Center at the University of California,
San Diego in La Jolla.
One reason family members’ risk was poorly understood is that a
diagnosis of fibrosis required a biopsy, which is a painful medical
procedure. But Loomba and colleagues devised a way to detect fat and
scarring in the liver using MRI scanning.
For the current study, Loomba and colleagues enrolled 26 patients
with NAFLD and cirrhosis, along with 39 of their parents or
siblings, as well as 69 people without liver disease plus 69 of
their first-degree relatives.
The study team took medical histories, performed medical
examinations and used MRI to evaluate the livers of all
participants.
They found that three quarters of the relatives of patients with
NAFLD and cirrhosis also had NAFLD.
Seven of these people, 18 percent of family members, also had
advanced liver fibrosis, compared to 1.4 percent of the relatives of
controls. The family members of NAFLD-cirrhosis patients were 12.5
times more likely to have liver fibrosis than the healthy comparison
families.
“The data's very compelling. It reinforces smaller and less
well-conducted studies that indicate a higher likelihood of
non-alcoholic fatty liver disease fibrosis among family members,”
said Dr. Scott Friedman, a liver disease specialist at Mount Sinai
Hospital in New York who wasn’t involved in the study.
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“So, it's important, because it may heighten our concern about the
risk of undiagnosed liver disease in first-degree relatives of
patients who've been diagnosed with NAFLD, particularly those who
have more advanced fibrosis,” Friedman said in a phone interview.
There has been a rising awareness and incidence of liver disease
associated with so-called metabolic syndrome, which is a
constellation of abnormalities usually including obesity, insulin
resistance, high blood pressure and high blood fats, Friedman noted.
“We're still trying to understand, certainly, what's the cause, what
are the risk factors, who is at highest risk, how do we screen for
those patients, and what do we do when we detect disease,” he said.
It’s important to note that aside from genetic contributions,
first-degree relatives often share the same lifestyle habits, he
added.
Currently, there are no proven therapies except diet and weight
loss, which is hard to sustain. “But, there is an intense effort in
the pharmaceutical and biotech industry to come up with new drugs to
treat those conditions before it progresses to the cirrhotic state,
where cancer and liver failure are real concerns,” Friedman said.
Loomba said new therapies are emerging. “There are about five Phase
3 trials for the treatment of NASH and especially advanced fibrosis
in NASH.”
Once a patient develops cirrhosis, there’s a risk of developing
liver cancer and those individuals need to be screened for that,
Loomba added.
“We have a series of tests that need to be done on those
individuals. And then, if the patient is obese for example and if
they lose weight then you can even reverse fibrosis or progression
of the disease.”
SOURCE: http://bit.ly/2svhgCI The Journal of Clinical Investigation,
online June 19, 2017.
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