WASHINGTON — An increasing epidemic of fatty liver disease in the U.S. is likely to ruin the health of millions and cost billions of dollars a year, experts said here.
Some 65 million Americans have non-alcoholic fatty liver disease (NAFLD) and that number will reach 100 million by 2030, according to Scott Friedman, MD, of the Icahn School of Medicine at Mount Sinai Hospital in New York City.
And currently 16.5 million people have the most serious subtype of NAFLD, non-alcoholic steatohepatitis (NASH), a number that will rise to 27 million, he told reporters at the Liver Meeting, the annual conference of the American Association for the Study of Liver Diseases.
The numbers will drive — among other things — a 178% increase in the incidence of hepatocellular carcinoma (HCC), Friedman said during a media briefing aimed at raising a red flag over the issue.
“An epidemic is upon us that we have not fully recognized,” he said, adding “primary care providers don’t appreciate that many of their patients are harboring a silent disease.”
But it’s not just that doctors themselves don’t recognize the issue, commented Arun Sanyal, MD, of Virginia Commonwealth University in Richmond. “This is a social problem” that needs greater awareness on the part of healthcare providers, the public and the politicians, he said.
Rising rates of obesity are the force behind the epidemic of NAFLD, an umbrella term covering a spectrum that begins with accumulation of fat in the liver, followed by ballooning, scarring, cirrhosis, and eventually liver failure, cancer, and death.
Within a few years, Friedman said, the leading indication for a liver transplant will be advanced NASH.
But liver ailments are not the only outcome of NAFLD, according to Mary Rinella, MD, of Northwestern University’s Feinberg School of Medicine in Chicago. She listed a series of adverse outcomes, including:
- Premature death from all causes; one study found that 10-year survival of people with NAFLD was 77%, significantly lower than the 87% expected rate
- From 12% to 38% of people with NASH, depending on the study, die of cardiovascular causes
- Malignancy other than hepatocellular carcinoma
Because the driving force behind fatty liver disease is obesity, she noted, people with NAFLD are at risk for all of the complications of the metabolic syndrome, as well as issues specific to the liver.
Rinella noted that the number of liver transplants owing to advanced NASH has risen 68% in the past decade, while the number of available organs has only risen 11%. And the number of people with NASH on transplant waiting lists is expected to grow 55.4% by 2030, she added.
Clinical outcomes aside, patients report their life gets worse as their NAFLD advances, said Zobair Younossi, MD, of the Inova Health System in Fairfax, Virginia. They report a “terrible impairment” of their quality of life, he said.
And there is some clinical evidence that reversing liver scarring can also reverse that downward spiral in quality of life, he said, although few interventions have that effect.
Moreover, the cost is enormous, he said. Younossi and colleagues reported here on models estimating that nearly 10 million adults are currently afflicted with NASH in the U.S. — about 6.5 million with advanced NASH.
The lifetime cost burden for those people was estimated at $972 billion for NASH as a whole and $631 billion for advanced disease, Younossi said.
The obvious solution for the individual patient is to lose weight, Friedman said, but in many cases he or she might need to lose 7% to 10% of body weight to start reversing the NAFLD. And even if they succeed, he said, it is often difficult to keep the pounds off.
“Cardiovascular disease, cancer, fatty liver — all have a common root cause,” Sanyal commented. That, he said, is a sedentary lifestyle with too much of the wrong kind of food and marketing that pushes people that way.