Examining consequences beyond the liver for non-alcoholic fatty liver disease
Our research into non-alcoholic fatty liver disease (NAFLD) has driven better care, new guidelines, training and advocacy.
Southampton BRC established that a range of conditions have heightened risk with NAFLD and drove new guidance that is now used in local healthcare
Working with patients and the public, we trialled omega-3 fatty acid supplements that were shown to reduce liver fat
Our breath-test studies have triggered the development of rapid, non-invasive diagnostics
Identified increasing risks
Non-alcoholic fatty liver disease (NAFLD) damages the liver through uncontrolled fat build-up.
Our studies demonstrated that NAFLD not only increases risk of chronic liver disease, but also other conditions. Those include cardiovascular disease, chronic kidney disease, type 2 diabetes and certain cancers (published here). We established a national Primary Care guideline for managing NAFLD drawing on this evidence. This is now used in our local healthcare system.
Professor Christopher Byrne is ranked first for NAFLD research in the UK over the last decade. A contributor to wider national and international guidelines, he has been UK Expert Diabetologist Advisor to:
NICE NAFLD guidelines (2016)
Heart UK (2016-)
Medicines and Healthcare products Regulatory Agency Chronic Liver Disease Working Group (2018)
International PanNASH Initiative (2019-)
UK EDEN Diabetes Group (2019)
Assessing nutritional supplements
Two key BRC trials have advanced NAFLD management and knowledge of the effects of nutritional supplements in this (published here).
These were developed through patient and public involvement (PPI) activity with patients from across the South coast. The WELCOME study looked at omega-3 fatty acid supplements. These were shown to reduce liver fat and increase beneficial omega-3 in other tissues (published here). That evidence informed the 2016 NICE NAFLD guidelines.
The INSYTE study trialled a ‘synbiotic’ supplement of healthy bacteria plus a sugar not absorbed by the gut. This improved fat processing in NAFLD. It reported improvements in levels of healthy gut bacteria, but no change in liver fat (published here). These results allowed experts to refocus efforts.
Breath-test diagnostic advances
We have also driven new breath-test diagnostics of liver function, measuring a type of carbon (13C). Our studies using this method detected impaired handling of nutrients in NAFLD. Patients with diabetes were shown to have greater impairment.
These results provided the basis for developing rapid, non-invasive diagnostics, published in 2021. They also informed the Joint Societies European Guidelines on indications, performance and clinical impact of 13C-breath tests in patients.
In 2020, NAFLD was reclassified as Metabolic (dysfunction) Associated Fatty Liver Disease (MAFLD). This allows for modest alcohol consumption with fatty liver disease. Highly relevant to the UK, MAFLD will be the focus of our future work.