Affecting approximately 25% of the population, fatty liver disease is a growing problem both in the US and worldwide, impacting people of all ages and backgrounds. Fatty liver disease, otherwise known as NAFLD (non-alcoholic fatty liver disease), is a term that describes a spectrum of disease that starts when fat accumulates in the liver.
Obesity is one of the main drivers of fatty liver disease along with type 2 diabetes, high blood pressure and high cholesterol. Patients with weight gain and these other risk factors, or a family history of fatty liver, should be closely monitored for this.
One of the ways the body responds to weight gain is to store it in the liver. That is because the liver is involved with fat processing and packaging. This fat then leaves the liver and is used up as energy. If more fat is being put in the liver than removed, the liver becomes progressively fatty.
The problem with this is that, over time, this fat can cause inflammation, and that is called NASH (non-alcoholic steatohepatitis). NASH is important because it can lead to progressive liver scarring and this, in turn, can lead to liver failure and liver cancer. One third of those with fatty liver will develop NASH. One third of those with NASH will develop extensive scarring of the liver, otherwise known as cirrhosis.
Non-alcoholic Fatty Liver Disease on the Rise
The incidence of NAFLD is increasing in parallel with increasing rates of obesity and type 2 diabetes. As a result, more and more people are developing NAFLD, and many are developing serious disease at a younger age. In fact, NASH is predicted to become the leading cause of end-stage liver disease, requiring liver transplantation, in the next decade.
Symptoms and Diagnosis of Fatty Liver Disease
Most fatty liver disease patients have no symptoms, and the disease can go undiscovered for years. It progresses silently and is typically only discovered when abdominal imaging is performed for other reasons, or blood work reveals abnormal liver enzymes.
Once NALFD is suspected or diagnosed, staging is important. This can include additional testing, including the following:
- FibroScan test — a noninvasive diagnostic device that detects and evaluates liver scarring
- MR elastography (MRE) — a noninvasive technology that combines magnetic resonance imaging (MRI) with low-frequency vibrations to create a visual map that shows stiffening of the liver caused by inflammation
- Liver biopsy — a procedure in which a small needle is inserted into the liver to collect a tissue sample for evaluation
Treatment — AdventHealth’s Fatty Liver Clinic
With fatty liver disease, early diagnosis and consistent care and monitoring are critical to achieving the best possible outcome.
Treatment options depend on whether fatty liver has progressed to NASH or liver scarring, such as cirrhosis. The mainstay of therapy, however, is weight loss and tight control of the risk factors. Five percent total body weight loss has been shown to lead to reversal of liver fat, and 10% total body weight loss leads to reversal of fat, inflammation and even some scar tissue.
Established in Winter Park in August 2020 and part of the Digestive Health and Surgery Institute, AdventHealth’s Fatty Liver program was developed specifically for those with fatty liver disease. By offering expert, subspecialty, focused liver care, we hope to provide effective solutions to an increasingly prevalent disease.
At the AdventHealth Fatty Liver Disease Clinic, we want to make it easy and bring the experts to the patient. We collaborate with leading providers across multiple disciplines within the organization to provide the most complete care possible. Our goal is to provide a one-stop shop where we evaluate, diagnose and provide appropriate personalized treatment options. The goal is early, comprehensive interventions in hopes of improvement and reversal of disease.
A multidisciplinary team provides ongoing support and progressive intervention, from targeted strategies for those at risk to treatment of patients suffering from advanced disease. The team also coordinates and communicates closely with patients’ other medical providers, including primary care, gastroenterology, endocrinology, surgery, psychiatry and others, to ensure that everyone is on the same page with the care plan.
In addition, a dedicated nurse navigator provides care coordination and maintains long-term communication with each patient to monitor his/her clinical progress. The nurse navigator also helps answer questions and provides guidance as patients learn about their disease and take steps to get better.
The Fatty Liver Disease Clinic offers the following:
- Lifestyle modification counseling
- Personalized disease counseling and guidance
- Patient education lecture series
- Medical weight loss
- NASH-specific therapies
- Referral for bariatric surgery for appropriate candidates
- Recruitment for clinical trials
- Referral for liver transplant for end-stage disease, if appropriate
- Long-term monitoring and management of disease
AdventHealth Actively Involved in Research to Identify New Fatty Liver Treatments
Because this is such a prevalent disease, with 25% of the population affected, many groups are working hard to find treatments to help reverse it. There are a number of new therapeutics for fatty liver disease in the pipeline. Because of the progressive and irreversible nature of the disease, early access to treatment is important. The AdventHealth Fatty Liver Clinic collaborates closely with AdventHealth’s Translational Research Institute to offer patients the chance to participate in clinical trials and get early access to the latest therapies.
Plans for Future Growth
Moving forward, AdventHealth hopes to expand access to fatty liver treatment by establishing additional Fatty Liver Clinics throughout Central Florida.
To schedule an appointment or refer a patient to the AdventHealth’s Fatty Liver Clinic.
Triple board certified in Internal Medicine, Gastroenterology, and Transplant Hepatology, Dr. Roman is the Medical Director for the Fatty Liver Disease program at AdventHealth, where she provides sub-specialty, comprehensive care for those with NAFLD. Additionally, she maintains clinics at AdventHealth Transplant Institute, where she provides care for those with advanced and end-stage liver disease. Her clinical specialties include management of patients with viral hepatitis, NASH/fatty liver, autoimmune liver disease, genetic liver diseases, alcohol mediated disease, liver cancer and cirrhosis. She also specializes in treating patients who require liver transplantation and manages their long-term post-transplant care. In addition, Dr. Torfay is a diplomate of the American Board of Obesity Medicine and is board certified in obesity medicine. She completed her Internal Medicine residency training at Boston University Medical Center in Boston, Massachusetts. She subsequently completed her Gastroenterology fellowship, as well as an advanced fellowship in Transplant Hepatology, at Vanderbilt University Medical Center in Nashville, Tennessee. Dr. Roman is a member of the American Association of the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), and American Society of Transplantation (AST).