The surprising reason fatty liver can double your death risk

Nonalcoholic fatty liver disease (NAFLD), a condition where fat builds up in your liver, is now known as metabolic dysfunction-associated steatotic liver disease (MASLD). But while the name may have changed, its severe health impacts have not.

Metabolic dysfunction, such as that caused by type 2 diabetes or obesity, could increase your odds of developing MASLD. Also, MASLD can lead to metabolic dysfunction-associated steatohepatitis (MASH), which can cause cirrhosis or severe liver fibrosis, a condition characterized by bands of scar tissue in your liver.

If you’re not careful, MASLD can set off a chain reaction that results in severe liver dysfunction or liver cancer, not to mention a higher risk of death from a host of causes — some not even liver-related…

Fatty liver and mortality risk

Researchers at the Karolinska Institutet identified 13,099 patients diagnosed with MASLD in Sweden between 2002 and 2020 and analyzed their risk of death from different causes compared to the general population.

Their findings were sobering. Overall, people with MASLD had almost twice the mortality rate of the general population!

The risk was elevated for almost all causes of death studied — but it was a whopping 27 times higher for liver disease and 35 times higher for liver cancer.

Interestingly, those weren’t the most prevalent causes of death…

The most common causes of death for these patients were cardiovascular disease, at a 54% higher mortality risk, and non-liver cancer, at a 47% higher mortality risk.

“Many people are not aware that they have fatty liver disease because it rarely causes any symptoms in the earlier stages,” says study lead Axel Wester, assistant professor at the Karolinska Institutet and physician at Karolinska University Hospital. “Our study shows that people diagnosed with MASLD have an increased risk of dying from many different diseases, not just liver disease.”

The study also found people with MASLD had an increased risk of dying from infections, gastrointestinal diseases, respiratory diseases, endocrine diseases or external causes.

“It is important that we do not only focus on the liver when treating patients with fatty liver disease,” says study lead Hannes Hagström, a professor at the Karolinska Institutet and senior physician at Karolinska University Hospital. “A holistic approach and early intervention involving different medical specialties can be crucial to improve the prognosis for these patients.”

Slimming down the liver

The estimates are that 35% of American have MSLD. How do you know if you’re one of them.

Unfortunately, symptoms of MASLD often don’t show up until the damage to the liver is already well underway. But if you have any of the following conditions, it’s safe to assume you may be developing MASLD as well:

• High cholesterol: especially triglycerides and LDL, and low HDL
• Obesity: a condition in which your body mass index (BMI) is 30 or higher (people who carry extra weight in their belly have a higher risk of MASLD)
• Insulin resistance: a condition in which cells in your muscles, fat and liver don’t respond to insulin the way they should
• Type 2 diabetes: a chronic condition that happens when you have perpetually high blood sugar

You may notice the symptoms above add up to metabolic syndrome. It fuels the disease.

If you do think you may be on the path to MASLD, there are a few steps you can take:

• Lose weight. Working to shed excess fat will have the same effect on your liver as the rest of your body. When you’re obese, doctors usually recommend shooting for at least a 10% weight loss, but even losing 3 to 5% of your body weight can make a difference.
• Exercise. An exercise regimen has benefits to the liver unrelated to weight loss. For starters, it enhances the protective capacity of Kupffer cells, which help maintain liver function.
• Manage your blood sugar. Try to avoid added sugar as much as possible, particularly sugary drinks like soda and sweet treats like candy and baked goods.
• Take care of your liver health. If you smoke or drink alcohol, stop. Both these behaviors put a great deal of stress on your liver.

There are also foods you can eat that support the liver:

• Coffee, which lowers abnormal liver enzymes.
• Tofu, which may reduce fat buildup in the liver.
• Fish rich in omega-3s, such as salmon, sardines, tuna and trout, can improve liver fat levels and reduce inflammation.
• Avocados, which contain chemicals that may slow liver damage.
• Low-fat milk and dairy products, which contain whey protein that may protect liver damage from advancing.
• Green tea, which may help shed liver fat.

Sources:

Fatty liver linked to increased risk of death from several diseases — EurekAlert!

Cause-specific mortality in 13,099 patients with metabolic dysfunction-associated steatotic liver disease in Sweden — Journal of Hepatology

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) — Cleveland Clinic