The National Health Service (NHS) describes non-alcoholic fatty liver disease (NAFLD) as a range of conditions that occurs due to the build-up of fat in the liver. This disease could lead to more severe conditions like non-alcoholic steatohepatitis (NASH: a condition that involves fat build-up in the liver with inflammation and liver cell damage) and cirrhosis (permanent scarring and hardening of liver), explains an account by Johns Hopkins Medicine.
A recent review article by a team of researchers from University of New England Biddeford, USA, published in Frontiers in Neuroscience, states that there is growing evidence that NAFLD is a significantly prevalent comorbidity with mental (psychiatric) disorders. The authors also mention that even though there is enough evidence associating NAFLD/NASH with psychiatric disorders, there isn’t enough work regarding the mechanism as to why this happens, and there exists a lack of guidelines in terms of patient care (from diagnosis till treatment).
Hence, in this paper, the team focuses on the various factors that can affect NAFLD development in people with mood disorders, with a specific focus on the effect of environmental factors (like psychiatric medications). This fatty liver disease affects nearly one-fourth of the world’s population, with its prevalence in children ranging from 5% to 10%.
The report discusses the prevalence of the fatty liver disease in people with psychiatric disorders: bipolar disorders, schizophrenia, anxiety, depression, chronic stress, and dementia; and mentions that genetic susceptibility insulin resistance, systemic inflammation, psychiatric medication, and socioeconomic factors can contribute to this prevalence.
In the case of pediatric (in children) fatty liver disease’s prevalence with mental disorders, the authors confirm that children with autism spectrum disorder, Down syndrome, and who are prescribed psychiatric medications— like atypical antipsychotics (AAs: antipsychotic medication with lesser side-effects), mood stabilizers, and selective serotonin reuptake inhibitors (SSRIs: an antidepressant)—are at great risk (threefold) of having NAFLD.
Psychotropic medications (medication that affects brain functioning causing changes in mood, awareness, thoughts, feelings, or behaviour) include antidepressants, antipsychotics (used to treat psychosis), and mood stabilizers; and alter body weight as well as energy metabolism, states the article. For example, AAs can cause weight gain, insulin resistance, and alter glucose as well as fat metabolism by the liver, elucidates the report.
In addition, the article also explains mechanisms and factors that are common to NAFLD as well as mental disorders: obesity and insulin resistance, inflammation, oxidative stress, dysfunction of mitochondria, dysregulated iron metabolism, disruption in circadian rhythm of the body (in terms of consuming food, taking medication, and rest-active cycle), genetic factors, lean non-alcoholic fatty liver disease (LNAFLD: liver disorder in people with a normal body weight or BMI), weak gut health, smoking, social determinants (like poverty, food security, and healthcare access), and climate change.
Furthermore, the authors believe that despite the existence of proof of NAFLD association with medication for mental disorders, there is a lack of clinical data explaining the risk of fatty liver disease on consuming psychotropic drugs like AAs. Future work on this matter (alternative therapies or co-therapies for psychiatric disorders as well as using biomarkers (proteins) to diagnose NAFLD) is crucial for more informed prescriptions and patient care, state the authors.
