For a long time, hepatitis C was the most common liver disease in the U.S., but while we were off eating our Thanksgiving feast and watching hours of football and feel-good holiday specials, another liver disease slipped into the number one spot. Nonalcoholic fatty liver disease (NAFLD) is a disease that is as it sounds, caused by a fat-filled liver. Left unchecked, this largely lifestyle-related illness can cause cirrhosis. Perhaps this condition would be taken more seriously if it were named “slow death of the liver by fat.”
In the December 2016 issue of Hepatology, Veronica Setiawan and colleagues examined the prevalence of chronic liver disease and cirrhosis in the U.S. (Prevalence of Chronic Liver Disease and Cirrhosis by Underlying Cause in Understudied Ethnic Groups). They analyzed 106,458 Medicare claims between 1999 and 2012 and found 5,783 cases of chronic liver disease without cirrhosis and 2,208 cases of cirrhosis. More than half (2,990/51.7 percent) had NAFLD.
Looking at chronic liver disease among various ethnic groups, NAFLD was the most common cause of cirrhosis in Japanese Americans, Native Hawaiians, and Latinos. The most common cause of cirrhosis in whites was alcoholic liver disease. Chronic hepatitis C virus infection was the most common cause of cirrhosis in blacks.
We are a long way from curing everyone who has hepatitis C. First, more than half of those who are infected are still undiagnosed. Second, access to hepatitis C treatment is still a huge problem. Third, new cases of hepatitis C are arising quickly, a consequence of the opioid epidemic in the United States. However, with better treatments, hepatitis C can be eradicated. But NAFLD is a huge threat without an simple lifestyle cure.