Reversing nonalcoholic fatty liver disease

One out of every four Americans has fatty liver disease, a condition where excess fat builds up in the liver and can cause damage.

Most people don’t know they have fatty liver disease. There are no symptoms.

It wasn’t on Kerry Sivia’s mind when she landed in the emergency room with severely swollen ankles in 2021. The then-36-yearold was diagnosed with nonalcoholic fatty liver disease (NAFLD) — a version of the disease where alcohol isn’t a contributing factor — and cirrhosis of the liver.

Cirrhosis is rare for someone Sivia’s age, especially since she rarely drank alcohol and has no family history of liver disease. However, when she was diagnosed, she weighed 310 pounds. Obesity is one of the main causes of NAFLD.

Sivia’s fatty liver disease probably went undiagnosed for a decade or more and likely caused her cirrhosis, said University of Chicago Medicine hepatologist Mary E. Rinella, MD, Sivia’s physician and an expert on fatty liver disease.

People with obesity and Type 2 diabetes should be screened for fatty liver disease, according to new recommendations published in January 2023 by the American Association for the Study of Liver Diseases. Rinella said the screening involves a simple blood test called FIB-4.

“If you can catch fatty liver disease early, and you’re able to treat it, then you should be able to prevent the development of cirrhosis,” said Rinella, who runs UChicago Medicine’s Metabolic and Fatty Liver Disease Clinic.

The FIB-4 test estimates liver scarring based on age, platelet count and liver enzyme levels. If the results exceed certain thresholds, the person should be assessed with a liver stiffness test called a FibroScan™ to determine if there’s evidence of serious liver disease.

While not everyone with obesity or Type 2 diabetes develops liver disease, the growing obesity epidemic means more people are at risk. According to Rinella, anyone who either has health issues, drinks three or more alcoholic beverages daily or has a family history of cirrhosis should ask their doctor about a FIB-4 screening.

Sivia, now 38, was able to reverse her NAFLD by revamping her diet and exercising regularly, with support from the Metabolic and Fatty Liver Disease Clinic. She’s lost 100 pounds and halted the progression of her cirrhosis.

“Kerry really took the bull by the horns and got it together. She’s very inspirational. And she extended her own life,” Rinella said. “She could have helped herself more if she’d been screened for fatty liver disease 10 years ago. She’s a perfect example of why diagnosing it in the early stages can be transformational.”

Sivia hopes her story will inspire others to get tested for fatty liver disease and realize they can reverse the disease with weight loss.

Today, Sivia works as an administrative assistant and just started an Instagram blog about healthy living. She looks and feels better than ever.

“As much success that I have with this, I still have liver cirrhosis. I still have things as a result of that to deal with,” said Sivia, who lives in Gurnee. “With the guidance and support of Dr. Rinella and her team, I’ve been able to reverse my NAFLD and slow, or maybe even stop, my cirrhosis. I’m not currently in need of a liver transplant. I hope to keep it that way.”

Fatty liver disease is about to overtake alcohol as the main reason for liver transplants. The number of liver transplants due to fatty liver disease has increased fivefold over the last 10 years, Rinella said. Fatty liver disease quadruples a person’s chances of getting diabetes (if they don’t have it already) and increases their risk of heart disease and cancer.

“Fatty liver disease is a silent condition that’s slowly taking over as a really big cause of death and disease. But, we can change the narrative if we, as a healthcare community and society, take decisive steps to increase awareness and implement simple methods to identify those at greatest risk of cirrhosis,” Rinella said.