Advanced Prostate Cancer
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Non-Alcoholic Fatty Liver Disease (NAFLD)

News item below [1], followed by the impact on PCa.

While obesity is the most obvious accomplishment of the American Food Pyramid (high-carb, low-fat), it has also created an epidemic of non-alcoholic fatty liver disease (NAFLD).

"Some 65 million Americans have non-alcoholic fatty liver disease (NAFLD) and that number will reach 100 million by 2030, according to Scott Friedman, MD, of the Icahn School of Medicine at Mount Sinai Hospital in New York City."

"And currently 16.5 million people have the most serious subtype of NAFLD, non-alcoholic steatohepatitis (NASH), a number that will rise to 27 million, he told reporters at the Liver Meeting, the annual conference of the American Association for the Study of Liver Diseases."

"The numbers will drive -- among other things -- a 178% increase in the incidence of hepatocellular carcinoma (HCC), Friedman said during a media briefing aimed at raising a red flag over the issue."

"An epidemic is upon us that we have not fully recognized," he said, adding "primary care providers don't appreciate that many of their patients are harboring a silent disease.""

"Rising rates of obesity are the force behind the epidemic of NAFLD, an umbrella term covering a spectrum that begins with accumulation of fat in the liver, followed by ballooning, scarring, cirrhosis, and eventually liver failure, cancer, and death."

"Within a few years, Friedman said, the leading indication for a liver transplant will be advanced NASH."

"But liver ailments are not the only outcome of NAFLD, according to Mary Rinella, MD, of Northwestern University's Feinberg School of Medicine in Chicago. She listed a series of adverse outcomes, including:

- Premature death from all causes; one study found that 10-year survival of people with NAFLD was 77%, significantly lower than the 87% expected rate

- From 12% to 38% of people with NASH, depending on the study, die of cardiovascular causes

- Malignancy other than hepatocellular carcinoma

"Because the driving force behind fatty liver disease is obesity, she noted, people with NAFLD are at risk for all of the complications of the metabolic syndrome, as well as issues specific to the liver."

"Rinella noted that the number of liver transplants owing to advanced NASH has risen 68% in the past decade, while the number of available organs has only risen 11%. And the number of people with NASH on transplant waiting lists is expected to grow 55.4% by 2030, she added."

"Clinical outcomes aside, patients report their life gets worse as their NAFLD advances, said Zobair Younossi, MD, of the Inova Health System in Fairfax, Virginia. They report a "terrible impairment" of their quality of life, he said."

(see link for full text [1])


"NAFLD is regarded as a hepatic manifestation of the metabolic syndrome because it is closely related to insulin resistance, obesity, type 2 diabetes mellitus (DM), and dyslipidemia (Angulo 2002)." [2]

An unexpected benefit of type 2 diabetes is a reduced risk for PCa. Similarly, advanced NAFLD appears to protect against biochemical recurrence [BCR] after radical prostatectomy. [2]

"When NAFLD patients were stratified according to NAFLD fibrosis score, we found that the severity of fibrosis had significant correlation with BCR. In other words, it could be inferred that the risk of BCR decreased as NAFLD progressed to nonalcoholic steatohepatitis or cirrhosis with histological progression of fibrosis."



[2] erc.endocrinology-journals....

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