Each week patients come through the Gastrointestinal/Hepatology Clinic in The Kirklin Clinic, and each week Tracey Gwaltney sees more and more of them diagnosed with non-alcoholic fatty liver disease.

Tracey Gwaltney (left), nurse practitioner for the UAB Liver Center, and Cindy Joiner, nurse research manager, will educate the community on the risks of fatty liver disease and how it can be prevented at the next Liver U program.

The Liver Center is in the midst of a patient and community education program aimed at informing people in the greater Birmingham area of the risks of fatty liver disease and how it can be prevented. “Liver U — Straight Talk for Your Health” is a forum led by Gwaltney and Nurse Research Manager Cindy Joiner. The campaign emphasizes the prevention and treatment of liver disease and highlights the issues faced every day by those living with the disease.

The next Liver U program is scheduled Thursday, April 16 from 6 to 8 p.m. at Berry Middle School Library in Hoover. The program is free and open to the public, but registration is requested. Call 975-6972 to register or e-mail your name, telephone number and that you wish to register for Liver U on April 16 to LiverCenter@uab.edu.

The first Liver U meeting was held in February at the Gardendale Civic Center. Twenty-five members of the community attended the event; they learned about different types of liver disease, prevention and treatments.

“We found this type of education was needed through our fundraising efforts in the community,” says Sheri McFall, administrative associate in the Liver Center. “This really began with our Liver Awareness Day and Liver Awareness Walk this past September. More than 60 people attended Liver Awareness Day and gave us several suggestions for future programs we could provide. Our evaluations led us to believe taking the liver program into the community would be a good outreach project and our Liver Walk, which included 75 participants, raised more than $21,000. That money goes into our patient/community education fund to help support our mission of providing educational information on liver disease to the public.”

What is fatty liver disease?
Non-alcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver diseases ranging from the most common, fatty liver (accumulation of fat in the liver, also known as steatosis), to non-alcoholic steatohepatitis (NASH, fat in the liver causing liver inflammation), to cirrhosis (irreversible, advanced scarring of the liver as a result of chronic inflammation of the liver). All stages of non-alcoholic fatty liver disease are now believed to be due to insulin resistance, a condition closely associated with obesity. In fact, the Body Mass Index (BMI) correlates with the degree of liver damage; the greater the BMI the greater the liver damage.

Non-alcoholic fatty liver disease is currently the most common liver disease in the United States and worldwide, affecting an estimated 10-24 percent of the world’s population, according to Medicine Net.com. The Centers for Disease Control and Prevention reports that approximately one half of the U.S. adult population is overweight with a BMI greater than 25. One quarter of the U.S. adult population is obese with a BMI greater than 30. That means more than 29 million Americans have non-alcoholic fatty liver disease, while 6.4 million of these persons have non-alcoholic steatohepatitis. Add to that the prevalence in children and it becomes increasingly alarming.

“We can attribute this increase primarily to people’s eating habits. People do not realize how food and beverages high in fat and sugar can cause this to occur. This also can be due to genetics and obesity in this population,” Gwaltney says. “They’re also not getting enough exercise. That combination leads to an unhealthy amount of excess fat all over the body, putting people at an increased risk for the disease.”

Non-alcoholic fatty liver disease causes no symptoms in most patients. It’s often discovered when routine blood tests show slightly elevated levels of liver enzymes in the blood. It also can be discovered when an ultrasound examination of the abdomen is done for other purposes (including looking for gallstones) and fat is found in the liver.

The bad news for those diagnosed with the disease is that no standard treatment for non-alcoholic fatty liver disease exists. Joiner says many of the medications that are being studied focuses on reducing inflammation of the liver, not treating or managing the disease. That means doctors typically work to treat the risk factors that contribute to the disease. For instance, if you’re obese, your doctor will help you to lose weight through diet, exercise and in some cases medications and surgery.

“There are new therapies in development to help treat fatty liver disease, but many of those are in the clinical research phase and not available on the market,” Joiner says. “We will have a study very soon using one of these new medications to test the efficacy and safety of using the drug in patients who have been diagnosed with fatty liver disease.”

More forums to come
The Liver Center plans to conduct other Liver U forums later this year in the Bessemer/McCalla area and the Huffman/Robuck area. Plans also are under way for the 2009 Liver Awareness Day and the 2009 Liver Walk, which is scheduled August 21-22.

“Our mission is to continue to offer specialized care to children and adults with all types of liver and biliary tract diseases, develop research programs to support clinical care and educate professionals and the public about liver disease,” McFall says.