Polypharmacy in Fatty Liver Disease: Prevalence and Side Effects

When many pills meet a sick liver: Polypharmacy and its pitfalls in fatty liver disease

An article by Jürg Hösli, the Swiss nutrition expert

Dear reader,

in my daily work, I constantly encounter people struggling with complex health challenges. One of these challenges, which has dramatically gained importance in recent years, is metabolic dysfunction-associated steatotic liver disease, or MASLD (formerly known as NAFLD or fatty liver). It is the most common chronic liver disease worldwide and is often closely linked to obesity, diabetes, and cardiovascular diseases.

But what happens when a variety of other medications, necessary to treat co-morbidities, are added to this complex liver disease? A recent study by Sarah Armes, Jenneffer Tibaes, and Ramya Rajaram, published in the renowned BMJ Nutrition, Prevention & Health, sheds light on precisely this important topic: so-called polypharmacy and its potential side effects in MASLD patients.

1. Introduction: The silent danger in our midst

MASLD is not a harmless diagnosis. It can progress from simple fatty liver to inflammation (MASH), liver cirrhosis, and liver cancer. Since MASLD often goes hand in hand with other chronic diseases such as type 2 diabetes, high blood pressure, high cholesterol levels, and obesity, it is not surprising that affected individuals often have to take a whole range of medications. This phenomenon – the simultaneous intake of five or more medications – is what we call polypharmacy.

At first glance, this may seem necessary to get all symptoms under control. However, every medication carries potential risks, especially when several active ingredients are simultaneously active in the body. They can influence each other, further burden the liver, or cause unexpected side effects. The mentioned study aimed to investigate the frequency of this polypharmacy in MASLD patients and to find out what side effects might be associated with it.

2. Key findings of the study: A look behind the numbers

The study by Armes et al. confirms what many doctors and nutritionists observe in practice:

• High prevalence of polypharmacy: Polypharmacy is widespread in people with MASLD. The authors emphasize that the complex treatment of co-morbidities often leads to a high number of prescribed medications. This is a crucial point, because the more medications are taken, the higher the risk of interactions and adverse events.
• MASLD as a catalyst for complexity: Fatty liver disease itself is an indicator of a complex health condition. It is rarely isolated, but almost always part of a metabolic