Nonalcoholic Fatty Liver Disease (NAFLD)

What is a Nonalcoholic Fatty Liver Disease (NAFLD)?

This is a condition characterized by an excess of fat in the cells of the liver. The liver is the largest organ in the body and plays a role in processing everything that you eat, drink, breathe, and absorb through your skin. When fat makes up at least 10 percent of the liver it is called “fatty liver.” NAFLD can range from fatty liver to the more serious nonalcoholic steatohepatitis (NASH), cirrhosis, and liver failure. Changes in the liver from the nonalcoholic fatty liver are similar to those that result from drinking too much alcohol. It requires attention to avoid the progression of liver disease.

Those who are considered to be overweight or obese with a BMI of 25 or higher may be at risk for NAFL. A person’s race or ethnicity may determine when his/her weight becomes a factor in the accumulation of fat in the liver. Some nationalities tend to be diagnosed with the fatty liver at a lower BMI. Those who tend to gain weight in their abdomen (belly) instead of their hips are more likely to develop fatty liver.

What Causes Nonalcoholic Fatty Liver Disease (NAFLD)?

The specific causes of NAFLD and NASH are unknown. However, factors that cause changes in the liver likely happen in a particular order:

1. A person is overweight or obese
2. Extra weight leads to insulin resistance–cells of the body do not allow insulin to transport sugar inside the cell
3. Fatty deposits develop in the liver
4. Some people develop inflammation in the liver from fat deposits. This is called nonalcoholic steatohepatitis or NASH.
5. NASH can lead to scar tissue in the liver.

Fatty liver does not always cause inflammation in the liver, however, it can progress to more serious liver diseases. Those with fatty liver who abuse alcohol or have other conditions that affect the liver are at the greatest risk.

1. Nonalcoholic steatohepatitis (NASH): inflammation in the liver caused by fat deposits in the liver cells. Inflammation in the cells can lead to scarring (fibrosis). The only way to tell the difference between NASH and fatty liver is by biopsy.
2. Cirrhosis: excessive scarring in the liver. Risk factors for the development of cirrhosis are diabetes, obesity, and alcohol abuse.
3. Liver failure: liver-related symptoms that result from scarring and continued damage of the liver. Both cirrhosis and liver failure are life-threatening conditions. People with cirrhosis are also at an increased risk for liver cancer.

What are the Symptoms of a Nonalcoholic Fatty Liver Disease (NAFLD)?

Most people with fatty liver disease do not have symptoms. Some people may describe being tired or having abdominal discomfort on the right side. Those who develop cirrhosis often do not have symptoms in the early stages. As it progresses, the following symptoms may develop:

• Yellowing of the skin or eyes (jaundice)
• Fluid collection in the abdomen (ascites)
• Bleeding in the esophagus, stomach, or intestines
• Mental confusion (encephalopathy)

How is it diagnosed?

There is not a specific test for diagnosis. It is often found during routine testing as most people do not have symptoms of fatty liver disease. The following tests may be obtained to make the diagnosis:

• Liver enzyme blood tests: ALT and AST may be elevated in people with fatty liver
• Ultrasound: imaging used to look at the size, shape, texture, and blood supply to the liver
• CT (computed tomography) and MRI (magnetic resonance imaging) scan
• Liver biopsy:  uses ultrasound and a needle to sample a small piece of the liver tissue. The results may show fat in the liver, inflammation caused by the fat, or scarring. This is the only way to confirm the diagnosis.
• Other causes of liver disease must also be evaluated

How is it treated?

Your healthcare provider will work to treat the underlying conditions that are contributing to your liver disease. Your healthcare provider may recommend weight loss and physical activity and may also prescribe medications to control cholesterol and blood sugar.  These interventions may reduce the amount of fat and inflammation in the liver and prevent progression to more serious liver disease.

Dietary recommendations include high fiber, small amounts of carbohydrates, particularly sugar, and reduced-fat.

Food selections:

• Fresh fruits and vegetables
• Whole grains
• Lean meats such as chicken, turkey, lean pork, and fish
• Low-fat dairy options

Exercise:

• May help to reduce abdominal fat
• May help control type 2 diabetes and high cholesterol

When to seek immediate medical advice:

If symptoms of cirrhosis include yellowing of skin/eyes, bleeding of the gastrointestinal tract, fluid collection in the abdomen, or confusion develops, contact your healthcare provider.