Millions in west don't know they have aggressive fatty liver disease, study says

Personal risk, body size, and metrics

• Several commenters report fatty liver or risk signs despite only being mildly overweight or even at “normal” BMI.
• Emphasis that weight alone is misleading: body composition and visceral fat matter more.
• Suggestions to combine BMI with waist circumference to assess risk, as “belly weight” strongly correlates with metabolic issues.

Diet patterns and conflicting advice

• One person reports reversing moderate NAFLD in ~6 months by cutting fried food, most dairy, sugary snacks, and red meat, with modest weight loss.
• Others argue long‑standing guidance: less dairy, meat, sugar, and oils, but in practice this is weakly enforced and hard for many to follow.
• Counterpoint: high intake of meat and dairy can coexist with good liver and visceral fat metrics if overall diet is “whole foods” and minimally processed.
• Debate over evidence: some claim there’s little high‑quality data linking meat directly to fatty liver; refined sugars and processed foods are seen as stronger suspects.

HFCS, sugar, and “hidden” sweetness

• One camp blames high fructose corn syrup and alcohol as primary drivers, noting HFCS’s ubiquity in processed food.
• Others argue HFCS is nutritionally similar to table sugar (fructose:glucose ratios are close), so total sugar intake matters more than the specific sweetener.
• Disagreement over focus:
  • One side says targeting HFCS is useful because it raises label awareness and small sugar differences accumulate across foods.
  • The other warns HFCS “scaremongering” makes people underestimate sugar from “natural” sources (honey, “real sugar” sodas).
• Additional nuance: whole fruit (with fiber and bioactive compounds) is treated as metabolically different from juices and refined sugars.

Fasting as a potential intervention

• Some anecdata and small studies are cited suggesting extended or intermittent fasting can improve fatty liver indices, mainly via weight loss and improved insulin dynamics.
• Others stress that strong evidence is limited; fasting research is a tiny fraction of NAFLD literature.
• Risks raised: muscle loss, sarcopenia in “skinny fat” or older people, refeeding syndrome, triggering or masking eating disorders, and harm once cirrhosis is present.
• Several note the mental difficulty of caloric restriction and fasting; hunger is described as a dominant physiological and psychological force.

Study funding, numbers, and etiology

• Commenters track the Lancet paper’s funding to Novo Nordisk and Echosens (data modeling), plus public research grants; the funders reportedly had no role in study design or publication decisions.
• Some readers find the prevalence and diagnosis numbers in the news article numerically inconsistent or sloppily phrased.
• One person speculates about a possible infectious trigger for fatty liver, analogous to other diseases later tied to microbes; another dismisses this as unlikely, given its strong association (as presented) with sedentary lifestyle, poor diet, and alcohol.