Nonalcoholic fatty liver disease (NAFLD) — commonly seen in people with obesity and type 2 diabetes — is linked to numerous poor health outcomes, including a higher risk of death at advanced stages, according to a new study published in the New England Journal of Medicine.
Some estimates show that at least 50% of people with type 2 diabetes will develop NAFLD, and undiagnosed NAFLD has been shown to be quite common in this group. The high rate of undiagnosed cases is particularly bad news because there are strategies that can help slow or even halt the progression of NAFLD — including losing weight and taking certain diabetes medications. It has even been shown that drinking coffee may help reduce the risk for NAFLD.
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More advanced NAFLD linked to higher risk of dying
For the latest study, researchers followed 1,773 adults with NAFLD for a median of four years to look at different outcomes linked to the disease. Not surprisingly, they found that the risk of dying increased with more advanced stages of NAFLD. For people with NAFLD in stages F0 to F2 — indicating no to moderate fibrosis, a less severe form of liver damage — the risk of death was 0.32 per 100 person-years. For people in stage F3 — indicating a more severe form known as bridging fibrosis — the risk of death was 0.89 per 100 person-years. For people in stage F4 — indicating cirrhosis, the most severe form of liver damage — the risk of death was 1.76 per 100 person-years.
Compared with participants who had NAFLD in stages F0 to F2, those with stage F4 disease had a higher incidence of type 2 diabetes — 7.53 compared with 4.45 cases per 100 person-years. They also tended to have a nearly 40% reduction in estimated glomerular filtration rate (eGFR), a measure of kidney function. With advancing stages of NAFLD, people were also at higher risk for liver-related complications, including major structural problems known as decompensation events (such as variceal hemorrhage, ascites, or encephalopathy). After adjusting for several factors — including age, sex, race, and diabetes status — the researchers found that any decompensation event in the liver was linked to 6.8 times the risk of dying, compared with not having such an event.
These results point to the need to prevent NAFLD from advancing to stage F3 or F4 to help prevent the worst outcomes of the disease — something that can only be done if NAFLD is recognized and treated in its earlier stages. Talk to your doctor about the possible benefits of getting tested for NAFLD if you think you may be at high risk for the disease based on having type 2 diabetes and obesity, or if you have blood test results that show signs of potential liver disease.
Want to learn more about protecting your liver? Read “Preventing Fatty Liver (NAFLD),” “Diabetes and NAFLD,” and “Hepatitis C and Diabetes: Is There a Link?”
