Fatty liver disease: putting the spotlight on a silent menace for young adults

One of the processes that drives progression to cirrhosis involves fat accumulation in the liver related to alcohol or obesity—namely alcohol-related fatty liver disease and non-alcoholic fatty liver disease (NAFLD)—with identical histological patterns. In this issue of The Lancet Gastroenterology & Hepatology, Kushala W M Abeysekera and colleagues 1 Abeysekera KWM Fernandes GS Hammerton G et al. Prevalence of steatosis and fibrosis in young adults in the UK: a population-based study. Lancet Gastroenterol Hepatol. 2020; (published online Jan 15)https://doi.org/10.1016/S2468-1253(19)30419-4 Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar present an insightful report on the threat of fatty liver disease in young adults aged 22–26 years enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). One in five of the young participants had a fatty liver, severe in almost half of cases, and one in forty had evidence of liver fibrosis. Alcohol intake, even when hazardous (Alcohol Use Disorders Identification Test-C score ≥5) or of a level equivalent to alcohol use disorder, was not a significant determinant of steatosis, which was mainly linked to obesity (based on body-mass index [BMI]) and visceral obesity (based on waist-to-height ratio), and to the presence of metabolic syndrome, and thus ultimately attributable to NAFLD. The study has the unquestionable merit of highlighting the burden of NAFLD in young adults; furthermore, it confirms the amplificatory synergy of alcohol and obesity on liver fibrogenesis, while disproving the hypothesis of a beneficial effect of moderate alcohol consumption in NAFLD. 2 Dunn W Sanyal AJ Brunt EM et al. Modest alcohol consumption is associated with decreased prevalence of steatohepatitis in patients with non-alcoholic fatty liver disease (NAFLD). J Hepatol. 2012; 57: 384-391 Summary Full Text Full Text PDF PubMed Scopus (169) Google Scholar Prevalence of steatosis and fibrosis in young adults in the UK: a population-based studyOne in five young people had steatosis and one in 40 had fibrosis around the age of 24 years. The risk of fibrosis appears to be greatest in young adults who have harmful drinking patterns and steatosis. A holistic approach to the UK obesity epidemic and excessive drinking patterns is required to prevent an increasing health-care burden of adults with advanced liver disease in later life.