Non-alcoholic fatty liver disease (NAFLD) increased rapidly among Americans between 1988 and 2018, according to findings presented at the Endocrine Society’s annual meeting.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), its more severe form, are responsible for a growing burden of advanced liver disease worldwide. Experts estimate that around one third of Americans have fatty liver disease. The buildup of fat in the liver can lead to inflammation, fibrosis, cirrhosis and liver cancer. Linked to obesity and diabetes, fatty liver disease is increasingly recognized as a metabolic disorder. With no effective approved therapies, management depends on lifestyle changes such as diet, exercise and weight loss.

Researchers reported a 131% increase in NAFLD from 1988 to 2018, according to a news release. In the same period, obesity increased by only 74, affecting 40% of Americans by 2018, researchers noted.

“This is an important condition that seems to be getting worse over time,” said study author Theodore Friedman, MD, PhD, chair of internal medicine at the Charles R. Drew University of Medicine & Science, at the annual meeting. “The rate has increased more than the rate of obesity in the United States.”

White Americans saw the most significant increase in NAFLD: a 133% rise during this period, affecting about 35% of the population. Obesity in white Americans increased by 77% during the same period.

Mexican Americans were the most likely to develop NAFLD compared with other ethnic groups: 58% of the population was affected in 2018. From 1988 to 2018, NAFLD among Mexican Americans increased by about 61% and obesity increased by 58%.

Black Americans were least likely to develop NAFLD, with about 25% of the population affected. Despite this, the disease increased 127% between 1988 and 2018, with a 59% increase in obesity.

“If you look at it, it’s across all races, all ethnicities and even in Black individuals, who traditionally have been thought to have much lower prevalence of [NAFLD], it’s still increasing in that group as well,” said endocrinologist Anastasia-Stefania Alexopoulos, MBBS, MHS, at the meeting.

Researchers blame the significant increase in NAFLD on unhealthy lifestyle habits such as a poor diet and lack of exercise. Risk factors for developing NAFLD include obesity, type 2 diabetes or metabolic syndrome.

Friedman and Alexopoulos emphasize that NAFLD can be reversed with a healthy diet, consistent exercise and weight loss.

“If you lose even 5% of your body weight, you can reverse some of the fat in the liver,” Alexopoulos said. “If you lose more than 7% to 10% of your body weight, you can actually reverse scarring.”