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Viral Hepatitis and Liver Disease

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Non-Alcoholic Fatty Liver Background

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Background - Non-Alcoholic Fatty Liver

Non-alcoholic fatty liver (NAFL) affects nearly 1 in 3 Americans, is increasing in the Veterans Health Administration, and requires action. It is most common in people living with diabetes (40-70%) or obesity (61-95%), with higher rates in older or Hispanic patients. NAFL independently increases the risk of diabetes (2-5 fold), heart and kidney disease, cirrhosis, liver cancer, and death. It also impairs health-related quality of life.

NAFL varies in severity. Of all patients living with NAFL:

  • 65-70% have simple fatty liver (fat accumulation in more than 5% of liver cells).
  • 25-30% have nonalcoholic steatohepatitis (NASH) with liver fat, inflammation, and injury, and elevated levels of alanine aminotransferase (ALT) in the blood.
  • 4% have NAFL cirrhosis and/or hepatocellular carcinoma.

NAFL is the most frequent cause of asymptomatic ALT elevations in primary care patients. The condition usually progresses slowly over decades, with greater progression in people living with diabetes or other liver diseases. NAFL in combination with advanced fibrosis increases mortality and liver-related events, including transplantation.