[Misc] Non alcoholic fatty liver

[Bruno’s Wig]

If you have the money, it might be worthwhile seeing a nutritionist who could advise you about food and supplements. .

 

[trueblue]

On food matters, I’ve read it’s better to seek a registered dietician. They’re guaranteed to be qualified and regulated by law. Some nutritionists have studied too but anyone could claim to be one.

 

[Screaming J]

I've had it diagnosed for about 3 years now, and was told it was probably a by-product of all the insulin I've been taking to manage my diabetes for the last 15 years or so


On medical advice I now hardly drink alcohol at all which has improved my liver readings (couldn't quote you the numbers or what they mean). And the scans have shown that while parts of my liver are f*cked it's still working OK and no signs of cancer.

I'm on atorvastatin and ramipril but that predated the NAFLD diagnosis. I've got used to (some) AF beers (Guinness 0.0 and Shipyard are the best imho) and I've discovered that if you put 1/2 teaspoon of balsamic vinegar in a wine glass and then add alcohol free red wine you do get some of the Welly from drinking the real stuff. Still not exactly like the real thing but a real improvement!

 

[jcdenton08]

MRI result back quite quickly. My GP has updated my NHS app with “acceptable - no action”, so I guess I won’t expect a phone call from them. The notes from the report say:

“Within the anterior aspect of segment five is a well-defined high signal T2 lesion measuring 25 by 24 mm. The appearances are consistent with a small haemangioma with no concerning features. No other significant findings. Conclusion: Segment 5 hepatic haemangioma of no concern.”


After a little googling this seems to be a not uncommon (about 1 in 20) small lesion which is not cancerous and should have no impact on my health.

Anyone else found of one these or can shed any further light? Thanks!

 

[Zeberdi]

MRI result back quite quickly. My GP has updated my NHS app with “acceptable - no action”, so I guess I won’t expect a phone call from them. The notes from the report say:

“Within the anterior aspect of segment five is a well-defined high signal T2 lesion measuring 25 by 24 mm. The appearances are consistent with a small haemangioma with no concerning features. No other significant findings. Conclusion: Segment 5 hepatic haemangioma of no concern.”


After a little googling this seems to be a not uncommon (about 1 in 20) small lesion which is not cancerous and should have no impact on my health.

Anyone else found of one these or can shed any further light? Thanks!

Rest assured if there was any concern at all, you’d be having further tests and not have been discharged. Just some knotty blood vessels that may even resolve on their own. MRIs and CT scans pick up all sorts of lumps and bumps now simply because the tests have become more available - they are mostly very common benign issues. Problem is, the people prone to anxiety about their health go over these reports looking for anything that is out of the ordinary - they then get anxious because the report is thorough enough to detail absolutely everything.

Sometimes, but not often, these scans do actually pick up something early which can be a live saver because you then get put into monitoring and review instead of discharge - you would know at the time though because the Consultant phones or makes a follow up appt. When I had my first MRI for the liver last July, it showed NAFLD but coincidentally also a tiny tumour in a side branch in my pancreas that never would have been found because it’s too early to have symptoms (and too small to biopsy safely) - I had another follow up MRI in January and one a few weeks ago to check the growth. Given pancreatic cancer has no symptoms until late stage (hence the poor survival rate) that could be a significant finding (I’m not at all worried as it’s being monitored now every 12 months) - If I had never had any scans for symptomatic drug-induced liver damage, I never would have known about the Pancreas.

The NAFLD can be controlled by diet (if it is diet related) - I developed mine after drug toxicity (high doses of intravenous antibiotics) damaged my liver.

I would probably raise the idea of having 6 monthly or annual liver functions tests with the GP though - these will be the first sign that your liver isn’t functioning properly.

Otherwise lots of low fat, non-processed food with plenty of fruit and veg for the NAFLD.

 

[jcdenton08]

Rest assured if there was any concern at all, you’d be having further tests and not have been discharged. Just some knotty blood vessels that may even resolve on their own. MRIs and CT scans pick up all sorts of lumps and bumps now simply because the tests have become more available - they are mostly very common benign issues. Problem is, the people prone to anxiety about their health go over these reports looking for anything that is out of the ordinary - they then get anxious because the report is thorough enough to detail absolutely everything.

Sometimes, but not often, these scans do actually pick up something early which can be a live saver because you then get put into monitoring and review instead of discharge - you would know at the time though because the Consultant phones or makes a follow up appt. When I had my first MRI for the liver last July, it showed NAFLD but coincidentally also a tiny tumour in a side branch in my pancreas that never would have been found because it’s too early to have symptoms (and too small to biopsy safely) - I had another follow up MRI in January and one a few weeks ago to check the growth. Given pancreatic cancer has no symptoms until late stage (hence the poor survival rate) that could be a significant finding (I’m not at all worried as it’s being monitored now every 12 months) - If I had never had any scans for symptomatic drug-induced liver damage, I never would have known about the Pancreas.

The NAFD can be controlled by diet (if it is diet related) - I developed mine after drug toxicity (high doses of intravenous antibiotics) damaged my liver.

I would probably raise the idea of having 6 monthly or annual liver functions tests with the GP though - these will be the first sign that your liver isn’t functioning properly.

Otherwise lots of low fat, non-processed food with plenty of fruit and veg for the NAFLD.

Great post, appreciated.

 

[chip]

Rest assured if there was any concern at all, you’d be having further tests and not have been discharged. Just some knotty blood vessels that may even resolve on their own. MRIs and CT scans pick up all sorts of lumps and bumps now simply because the tests have become more available - they are mostly very common benign issues. Problem is, the people prone to anxiety about their health go over these reports looking for anything that is out of the ordinary - they then get anxious because the report is thorough enough to detail absolutely everything.

Sometimes, but not often, these scans do actually pick up something early which can be a live saver because you then get put into monitoring and review instead of discharge - you would know at the time though because the Consultant phones or makes a follow up appt. When I had my first MRI for the liver last July, it showed NAFLD but coincidentally also a tiny tumour in a side branch in my pancreas that never would have been found because it’s too early to have symptoms (and too small to biopsy safely) - I had another follow up MRI in January and one a few weeks ago to check the growth. Given pancreatic cancer has no symptoms until late stage (hence the poor survival rate) that could be a significant finding (I’m not at all worried as it’s being monitored now every 12 months) - If I had never had any scans for symptomatic drug-induced liver damage, I never would have known about the Pancreas.

The NAFLD can be controlled by diet (if it is diet related) - I developed mine after drug toxicity (high doses of intravenous antibiotics) damaged my liver.

I would probably raise the idea of having 6 monthly or annual liver functions tests with the GP though - these will be the first sign that your liver isn’t functioning properly.

Otherwise lots of low fat, non-processed food with plenty of fruit and veg for the NAFLD.

All good, but biopsy is still the gold standard. From a recent publication, https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-022-00821-6:

"For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended."

MRI still isn't that good at determining level of NAFLD (of which there are many scales) "The PDFF correlated with the steatosis grade determined by biopsy in these patients; PDFF increased with increasing histology-determined steatosis score. Steatosis was nonlinearly associated with fibrosis, as determined by both PDFF and biopsy. Thus, a low level of steatosis does not necessarily mean that the patient has mild NAFLD." from Permutt, Z. et al. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease—MRI accurately quantifies hepatic steatosis in NAFLD. Aliment. Pharmacol. Ther. doi:10.1111/j.1365-2036.2012.05121.x

I'll PM you a link to my colleague's work, as his bio says: Ranked World Expert and 5th in the world by Expertscape for research in NAFLD (2010-2022) (2022), if you are inetersted. We did quite a lot of work together but he's much, much more knowledgeable than me.

 

[Zeberdi]

All good, but biopsy is still the gold standard. From a recent publication, https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-022-00821-6:

"For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended."

MRI still isn't that good at determining level of NAFLD (of which there are many scales) "The PDFF correlated with the steatosis grade determined by biopsy in these patients; PDFF increased with increasing histology-determined steatosis score. Steatosis was nonlinearly associated with fibrosis, as determined by both PDFF and biopsy. Thus, a low level of steatosis does not necessarily mean that the patient has mild NAFLD." from Permutt, Z. et al. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease—MRI accurately quantifies hepatic steatosis in NAFLD. Aliment. Pharmacol. Ther. doi:10.1111/j.1365-2036.2012.05121.x

I'll PM you a link to my colleague's work, as his bio says: Ranked World Expert and 5th in the world by Expertscape for research in NAFLD (2010-2022) (2022), if you are inetersted. We did quite a lot of work together but he's much, much more knowledgeable than me.

You misunderstood my post I think and you misunderstand the current research and causing unnecessary worry.

Non-invasive, quantitative assessment of liver fat by MRI-PDFF as an endpoint in NASH trials

Nonalcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease worldwide, and the progressive form of this condition, nonalcoholic steatohepatitis (NASH), has become one of the leading indications for liver transplant. ...

www.ncbi.nlm.nih.gov

An MRI may not be able to accurately gauge the fat level accumulated in the liver cells (obviously) but it is certainly capable of diagnosing at what stage chronic NAFLD has progressed if at all. Further more as the link above shows, new biomarkers in MR imaging have improved staging the level of fat deposits

 

[Birdie Boy]

A few years back I did a drug trial for NAFL. Doctor said I had a tiny amount of fatty liver and nothing to worry about as I have less than him! I had 2 biopsies, one at the start and one at the end. Unfortunately I do not know if I had the placebo or the new drug. I was in the first cohort of humans to have it, if I did!
I now live and work abroad and the doctors insist on blood tests every 3 months, I think just to claim on my Bupa insurance! Anyway, last time there were 37 tests done and all were normal. I do not know if a liver test was done. If anyone knows what to look for, I can view the results online at anytime.

 

[ROSM]

I once had life insurance refused for high gamma gt levels. Tests etc all looked at fatty liver and in the end I needed a consultant from a London hospital to write to the insurance Co to say it was not down to lifestyle of illness and that I was one of 10% of people with high gamma gt that was at raised levels due to genetics and was perfectly safe. I was then accepted and never had an issue with insurances since.

Ironically it has fluctuated every year- some years it's been said as normal and others as elevated despite it being within 20% of the baseline. (I am never as low as 5, am usually around 35 although once it went up to 80 and that was excused as each lab tests differently I was told)

 

[chip]

You misunderstood my post I think and you misunderstand the current research and causing unnecessary worry.

This is my neurodeviance, not meant to cause worry at all. Sorry if it did to anyone. I think all I was trying to say was that if the MRI is OK then monitoring is all that is needed.

I work more in vascular physiology but have spent a lot of time trying to link progression of NAFLD with vascular function and response to dietary, drug, exercise interventions in some quite large trials over years. I agree with everyting you've said, but the gold standard remains. I agree, biopsy is like useing doubly labelled water for physical activitity energy expenditure, not great for volunteers/patients when other reliable measures are available. I had lots of problems with NAFLD scores, often confounded by other factors, so tend to get hung up on limitations.

I shouldn't post late at night in the middle of the marking season.

 

[Zeberdi]

This is my neurodeviance,….I shouldn't post late at night

Ditto
Thanks for the info - Obviously there are/will be some posters for whom your research links are relevant ie those with progressive NAFLD, so they may take you up on your offer.

It probably should be noted that Hospital Consultants and GPs are not very receptive (understandably ) to patients armed with cutting edge clinical research into their conditions ( I know, I’ve tried it on more than one occasion ) - They have enough trouble managing conditions with what is already clinical practice. (They are more flexible with medication and off-label use!)

Looking at research can be a rabbit hole unless it’s your speciality and your research parameters are clearly delineated. The body and its physiological functions are, it goes without saying) all interconnected so it can be a non-ending data-mining exercise with frustrating outcomes unless you already have some medical research background.