People who have “belly fat” tend to have fat in and around their internal organs, including their liver. Fat in the liver—where it doesn’t belong–can cause nonalcoholic fatty liver disease (NAFLD), which is estimated to affect 36 percent of US adults.

According to a recent blog by Dr. Michael Greger (nutritionfacts.org), the prevalence of NAFLD in the U.S. has increased at least fivefold since the late 1990s, as a result of the rise in obesity. Even young adults and children can be affected—70 to 80 percent of obese children have NAFLD. The danger is that “fatty liver” can progress to liver inflammation called fatty hepatitis, which can cause scarring and liver cirrhosis. Furthermore, NAFLD increases the risk for liver cancer.

Diagnosis

• Anyone with belly fat should be suspected as having fatty liver until proven otherwise.
• Elevated (even mildly elevated) liver enzymes (SGOT, SGPT) on a chemistry panel should be suspected as being due to fatty liver, although rarely people with NAFLD have normal enzymes– at least early in the course of their disease.
• CT or MRI imaging of the liver can confirm fatty liver; ultrasound is the most cost-effective imaging test.
• Especially if liver enzymes are more than mildly elevated, and particularly if imaging doesn’t confirm fatty liver, other causes of liver disease need to be ruled out—such as chronic infectious hepatitis, alcoholic liver disease, and cancer.

Prevention of NAFLD

• Maintain ideal body weight but in particular avoid “belly fat.” Ideal waist circumference (measured at the point of greatest circumference) in a Caucasian man is < 40 inches and woman < 30 inches—cutoffs are lower in Asians and East Indians.
• Regular aerobic exercise helps prevent NAFLD, in part by controlling weight gain.
• Avoid added sugar, which studies have shown contributes to NAFLD.
• Avoid excess dietary fat—particularly saturated fat (found in animal products, and palm and coconut products) — which has also been shown to contribute to NAFLD.
• Whole grains are fine, but avoid processed carbohydrates.

Treatment

• There are medications that help treat fatty liver, such as the diabetic drug Actos (pioglitazone).
• The lifestyle recommendations listed under prevention help treat and reverse NAFLD. Dr. Greger notes that “healthy plant-based diets are linked to lower NAFLD risk and better liver function.” Eating more legumes can reduce fatty liver risk by up to 65 percent.
• While weight loss is important, “rapid weight loss can worsen the condition by flooding the bloodstream with excess fat.” Therefore, losing around three pounds a week is recommended.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.