Non Alcoholic Fatty Liver Disease (NAFLD) – An Emerging Challenge

A rapidly emerging cause of Chronic Liver Disease (CLD) is Non-alcoholic Fatty Liver Disease (NAFLD). In the West, the prevalence of NAFLD is as high as 30% and it is postulated that it may affect one-third of the population by 2030 [1]. Various studies have shown that the prevalence of NAFLD in Pakistan ranges from 14% to 47% [2]. The spectrum of liver damage in NAFLD is wide-ranging and essentially involves non-alcoholic causes of fat accumulation in the cells of the liver. This can also occur in other conditions where there is more than 5% steatosis. These conditions include chronic liver disease (CLD) caused by drugs (such as Methotrexate, Amiodarone, Tamoxifen etc.) or viruses (such as HCV), exposure to environmental toxins, malnutrition, hemochromatosis, Wilson’s disease, and any autoimmune disease triggering 5% steatosis [3]. There is a strong association of NAFLD with obesity (in more than 40% of patients) [4], hypertriglyceridemia (in 20% or more), diabetes mellitus (in 20% or more), and insulin resistance – all components of the metabolic syndrome [5]. Over the last two decades, rising trends of DM, obesity and insulin resistance have gone hand in hand with increasing prevalence of NAFLD [6]. Pakistan has a 17.1% incidence of Type-2 diabetes and a 14% incidence of NAFLD. There is a 32% incidence of NAFLD in Pakistani type 2 diabetics [7]. The National Health Survey of Pakistan conducted way back in 2006 depicted an incidence of obesity in 25% of the Pakistani population, and since then, numbers have continued to rise.