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How can I prevent liver disease?
Steatotic liver disease, also called SLD or fatty liver disease, has become highly prevalent in the general population; the current estimate is approximately 35 to 40 percent of people have some degree of SLD. Chronic liver diseases, for the most part, are silent diseases in that they don’ t typically cause any symptoms in the earlier stages. That’ s because the liver can really withstand damage and at the same time repair and regenerate— until it can’ t do so, typically after many years. The most common example is alcohol use: in the beginning, people may not have any symptoms related to their liver at all. Once people start having symptoms, like yellowing of the eyes or skin, or an abdomen full of fluid, they already have more advanced disease such as cirrhosis.
The other main cause of steatotic liver disease is metabolic dysfunction, which includes obesity, type 2 diabetes, and dyslipidemia. People with metabolic dysfunction who consume alcohol— even just a drink or two a day— are at particularly high risk of liver complications.
A lot can be done to prevent further progression and, in some cases, reverse the damage, and the interventions are pretty straightforward: alcohol cessation and management of the metabolic issues. People who have diabetes should get their A1c, which is a marker of glucose control, down to a reasonable range. People who are overweight or obese should work on their diet and exercise and lose some weight. Very recently, the FDA approved semaglutide( like Wegovy) and another drug, resmetirom, to treat metabolic-associated steatotic liver disease.
I continue to see people who don’ t make the connection between drinking and the health consequences of drinking. This is one disease where lifestyle modification intervention, including alcohol treatment intervention, can really slow down disease progression or even reverse it in many cases. If you have risk factors for SLD, your clinician can do a calculation called FIB-4, which uses routine blood test values to estimate liver damage, and refer you to a specialist as needed. Liver disease is common and it can be severe. But it’ s preventable.
Professor of Medicine Kittichai Promrat, MD, is a gastroenterologist and hepatologist with Brown University Health and interim director of the Division of Gastroenterology at Brown. Last spring he co-authored a small study of at-risk, asymptomatic patients that identified a high rate of liver disease using a portable diagnostic imaging tool. The researchers hope to conduct a larger study to assess the feasibility of making the screening more widely available. HD @ B
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