November 29, 2022 — “While nonalcoholic fatty liver disease (NAFLD) was associated with increased COVID-19 severity and ICU admission rates, it did not increase mortality in COVID-19 patients after adjustment of other confounding factors. However, it is alarming that at least 1 out of 3 can have fatty liver disease in the general population in the Philippines; [or] 38% prevalence rate versus 25% worldwide”.
Those data were mentioned by Dr. Janus Ong, associate professor, PGH Department of Medicine Division of Gastroenterology, at the Stop C.O.V.I.D. Deaths Webinar Series Special Edition.
An important public health problem, NAFLD is of two types—simple fatty liver and nonalcoholic steatohepatitis (NASH). The diagnosis of NAFLD requires the presence of fat in the liver, detected either by ultrasound imaging or biopsy. Patients should not have significant alcohol use, no secondary causes of fatty liver like medications, and have no other causes of liver disease. Often, patients have associated metabolic conditions like diabetes.
NAFLD is also quite common among diabetics with 57% prevalence rate. Left unchecked, NAFLD, now considered a multi-system disease, will eventually become NASH. This liver injury can later lead to cirrhosis, liver failure, or can eventually become liver cancer.
The NASH type is diagnosed solely by liver biopsy. For patients who cannot undergo biopsy, other non-invasive options that are available in the Philippines are vibration control transient elastography (VCTE) and 2D shear wave elastography (SWE) using ultrasound.
NAFLD is also quite common among diabetics with 57% prevalence rate. Left unchecked, NAFLD, now considered a multi-system disease, will eventually become NASH. This liver injury can later lead to cirrhosis, liver failure, or can eventually become liver cancer.
While screening of the general population is not recommended at this time, patients at high risk for fatty liver and its complications like Type 2 diabetes and those with persistently elevated liver enzymes in blood tests are advised to go through testing. Persistently elevated liver enzymes can point to an ongoing damage that needs treatment or can be a sign of inflamed or injured liver cells.
Since NAFLD is a multi-system disease, its management requires a multi-disciplinary team approach where specialists provide holistic care.
The current available treatments include four approaches: first, controlling overweight and obesity through diet and physical activity by agents that promote weight loss, or by surgery; second, aggressively treating the metabolic conditions to reduce cardiovascular disease risk; third, potentially reducing end-stage complications with other approaches; and fourth, targeting NASH with liver-directed treatment.
Dr. Ong, a hepatologist, recommended the following: 1)Mediterranean diet (nuts, seeds, legumes, whole wheat grain, fish, walnuts, fruits, vegetables, and olive oil), 2) active lifestyle, reduced sedentary behavior, and mental-being management (ex. yoga, aerobic exercise, resistance exercise), and 3) avoiding certain foods like processed meat, sweets, sugar, sweet-treated beverages, alcoholic beverages, and high fat and sugar diet.
Meanwhile, Dr. Elizabeth Paz-Pacheco, consultant of the UP-PGH Division of Endocrinology, Diabetes, and Metabolism discussed prevention of disease progression by controlling risk factors like high blood sugar, overweight, high cholesterol, and hypertension. Pursuing a lifestyle change that includes regular physical activity and keeping watch over food intake also help. Dr. Paz-Pacheco used the Mediterranean diet pyramid illustration to summarize the quick points that can be considered. Still, lifestyle modification as an intervention is complex, so she hopes that a national plan can be realized in the future.
The endocrinologist reported on the cluster of risk factors using the harmonized criteria. After looking at the usual anthropometrics and blood pressure determinations, five basic laboratory tests to check were mentioned. These are waist circumference using country-specific guidelines, blood pressure with cut off at 130/85, blood sugar with cutoff at 100 mg/dL, triglycerides cutoff at 150 mg/dL, and lipids of less than 40 mg/dL for males and less than 50 mg/dL for females. Having 3 out of 5 beyond the cutoff values may indicate that a patient has metabolic syndrome. The clear association of NAFLD is seen with the glucose and triglycerides.
Haziel May C. Natorilla
