Australia is facing an “epidemic” of non-alcoholic fatty liver disease (NAFLD), with 30,000 deaths predicted over the next decade, according to a modelling study from the University of Western Australia.

The trend is largely being driven by childhood obesity and the consumption of sugary drinks.

Even if obesity rates stabilise, NAFLD – which already afflicts about a third of Australian adults and is seen increasingly in children – cases are likely to rise 25 per cent by 2030.

The trend will lead to an increasing – and probably unmeetable – demand for liver transplants.

With hepatitis rates falling, non-alcoholic fatty liver disease will be the leading reason for liver transplants. Photo: Austin hospital

NAFLD is the most common form of chronic liver disease caused by an accumulation of fat in the livers of people who drink little or no alcohol.

It’s largely asymptomatic, but some people will suffer fatigue and experience pain of discomfort in the upper-right abdomen.

Increasing age, obesity, insulin resistance and diabetes are risk factors – but it’s reversible by adopting a healthy diet and doing some exercise.

Very few people take the resurrection route

The problem with NAFLD is that some people will develop the more severe and aggressive form of the disease, known as non-alcoholic steatohepatitis – this is where the liver becomes inflamed and eventually progresses to advanced scarring (cirrhosis) and liver failure.

The new study found that rates of non-alcoholic steatohepatitis will rise by 40 per cent – and the rate of decompensated cirrhosis by 85 per cent.

Decompensated cirrhosis is the term given to acute deterioration in liver function in a patient with cirrhosis – and is characterised by:

• Jaundice
• Ascites (accumulation of fluid, causing abdominal swelling)
• Hepatic encephalopathy (a decline in brain function that occurs as a result of severe liver disease)
• Hepatorenal syndrome (progressive kidney failure from severe liver damage), and/or
• Variceal haemorrhage (bleeding from abnormal vascular connections usually found in the oesophagus or stomach).

It’s a grim way to go.

The researchers predict the prevalence of non-alcoholic steatohepatitis in the general population will be 6.2 per cent by 2030 – about 1.85 million patients.

Liver-related deaths among people with NAFLD will rise by 90 per cent – from 1700 in 2019 to a peak of 3200 in 2030.

A global epidemic, starting in childhood

Associate Professor Simone Strasser is a Sydney hepatologist, president of the Gastroenterological Society of Australia, and co-author of the paper.

She said that with falling hepatitis rates, non-alcoholic steatohepatitis is likely to become the main reason why patients need liver transplants.

Many children are sowing the seeds for liver disease by eating a poor diet. They may be in their 50s or 60s when they discover the damage. Image: Ema Osavkov

“Transplant is always a surrogate for death,” Dr Strasser said.

“And we don’t have a surplus of organs, so it’s going to put increasing pressure on transplant services.”

Dr Strasser said many countries had modelled the non-alcoholic fatty liver disease burden, but the work hadn’t been done in Australia.

“We know there is a global trend of increasing obesity, increasing diabetes and increasing non-alcoholic fatty liver disease transplant … the problem was about modelling that epidemic in Australia, to see what this will look like in 2030,” she said.

“We’ve published other papers in this space about obesity and liver transplants … so we weren’t surprised by the results.”

But patients who don’t drink alcohol, or drink very little, tend to be surprised they have liver disease, because they’re not aware that poor diet is leading them toward the transplant list.

“It is very common for people to be shocked when told that their lifestyle has resulted in serious liver disease,” Dr Strasser said.

“There is significant ignorance in the community that obesity and diabetes are major risk factors for liver disease.

“Obesity and diabetes are also major drivers of liver disease in people with other risks, such as moderate alcohol consumption or viral hepatitis.

“Fatty liver disease can accelerate other liver diseases and is an important cause of liver disease and liver cancer in its own right.”

The most disturbing element of this epidemic is it increasingly begins in childhood.

“We know that 25 per cent of children, adolescents are already in the obese/overweight range,” Dr Strasser said.

“By the time they get to their 50s and 60s, they’ll have been exposed to obesity longer.”

The Gastroenterological Society of Australia has more information about liver disease here.