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The silent epidemic of NAFLD in Ireland

Professor Suzanne Norris

Consultant Hepatologist and Gastroenterologist 

Non-alcoholic fatty liver disease is caused by the build-up of fat in liver cells, which can lead to cirrhosis of the liver, with screening being recommended for people with type 2 diabetes.

There is a silent epidemic of NAFLD in Ireland. Cirrhosis of the liver may occur if left untreated or undiagnosed. However, awareness among patients and healthcare providers in this country is extremely low. This is leading to under-diagnosed, under-treatment and increased mortality.

What is non-alcoholic fatty liver disease?

NAFLD is an excess of fat in the liver. The absence of increased alcohol intake causes this. It may develop as:

Simple steatosis (fat): the accumulation of fat in the liver. This may slowly progress to liver inflammation and scar tissue (fibrosis) over many decades.

Non-alcoholic steatohepatitis (NASH): the more progressive and aggressive subtype of NAFLD, where inflammation results in cellular damage leading to fibrosis/cirrhosis.

It is in fact estimated that 25-30% of the global population have NAFLD, and 5-12% develop NASH. A recent Irish NAFLD screening initiative in 2017 of patients with type 2 diabetes mellitus (T2DM) reported that that one in five had advanced fibrosis/cirrhosis.

Diagnosing NAFLD

Research has proven that up to 80% of T2DM patients with NAFLD have normal liver blood tests. Consequently, the European Association for the Study of the Liver (EASL) Clinical Practice Guidelines (2016), strongly recommend that T2DM patients should be screened for NAFLD irrespective of liver enzyme blood levels, since T2DM patients are at risk of liver fibrosis.

Vibration Controlled Transient Elastography or FIBROSCAN® are innovative, unique, ultra-sound based technologies. FIBROSCAN®is used to screen for NAFLD. It does so through measuring liver stiffness, a marker of liver fibrosis. This non-invasive and painless method has the advantage of also tracking changes in liver fibrosis over time including post treatment assessments.

What is the treatment for NAFLD?

The main treatment is in fact lifestyle intervention including diet and exercise. Notably overall, studies have reported that 7–10% weight loss sustained over 48-weeks results in significant improvement in liver steatosis and inflammation. However, with significant weight-loss, lifestyle intervention can improve and reverse NAFLD/NASH.

The 2016 European guidelines also recommends that the aggressive form of NAFLD (NASH) should be identified in patients at risk. This includes those with T2DM or metabolic syndrome, and over 50 years of age. Similarly, given the potentially life threatening complications of undiagnosed liver disease, awareness of liver health in patients with diabetes is critical and should be incorporated in diabetic care pathways.

Source: Professor Suzanne Norris.
Consultant Hepatologist/Gastroenterologist, St James’s Hospital & Liver Wellness
Professor in Hepatology & Gastroenterology, Trinity College Dublin.

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