Nonalcoholic Fatty Liver Disease

A fatty liver is larger and a different color than a healthy liver. Microscopic views of the tissue show extra fat in a fatty liver. In some cases, there's also inflammation and scarring.

Nonalcoholic fatty liver disease (NAFLD) is a common liver problem that happens in people who don't drink much or any alcohol. Too much fat builds up in the liver. This is often seen in people who are overweight or obese.

NAFLD is becoming more widespread, especially in countries like those in the Middle East and the West, as more people struggle with obesity. It's the most frequent type of liver disease globally. NAFLD can range from a mild form, called fatty liver, to a more serious condition called nonalcoholic steatohepatitis (NASH).

In NASH, the fat buildup in the liver causes swelling and damage. NASH can get worse, leading to serious scarring of the liver (cirrhosis) and even liver cancer. This damage is similar to the harm caused by drinking too much alcohol.

Researchers are suggesting a change in the names of these conditions. Instead of NAFLD, they propose the name metabolic dysfunction-associated steatotic liver disease (MASLD). They also recommend changing the name of NASH to metabolic dysfunction-associated steatohepatitis (MASH). These changes reflect a better understanding of the underlying causes of these diseases, which are often linked to problems with how the body uses energy (metabolism).

The liver is the biggest organ inside your body, roughly the size of a football. It's mostly located in the upper right part of your abdomen, above your stomach.

Non-alcoholic fatty liver disease (NAFLD) is often silent, meaning you might not notice any problems. If you do, you might feel:

• Tiredness: Feeling unusually fatigued or lacking energy.
• Unwell: A general feeling of not being quite right, discomfort, or malaise.
• Belly pain: Pain or discomfort in the area just below your ribs on your right side.

More serious conditions like non-alcoholic steatohepatitis (NASH) and cirrhosis (severe scarring of the liver) can cause additional symptoms. These symptoms may include:

• Itchy skin: A persistent tingling or itching sensation on your skin.
• Swollen belly: Fluid buildup in your abdomen, called ascites. This can make your belly look bigger.
• Shortness of breath: Difficulty breathing comfortably.
• Swollen legs: Fluid buildup in your legs and ankles, causing swelling.
• Spider veins: Small, red, spider-like blood vessels that appear on the surface of your skin.
• Enlarged spleen: Your spleen, an organ that helps filter blood, may become larger than normal.
• Red palms: Your palms might appear red or flushed.
• Yellowing of skin and eyes (jaundice): Your skin and the whites of your eyes may turn yellow. This happens because of a buildup of a substance called bilirubin in the blood.

If you're experiencing ongoing health problems that concern you, it's important to schedule a visit with your doctor or other healthcare provider. Talk to someone about any symptoms that are persistent and bothering you. Don't hesitate to reach out for help.

Doctors don't fully understand why some people develop a buildup of fat in their livers while others don't. Similarly, they haven't pinpointed exactly why some fatty livers progress to a more serious condition called NASH.

Both non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are linked to several factors:

• Family history (genetics): If your family members have had these conditions, you might be more prone to developing them too. This means your genes may play a role.
• Carrying extra weight (overweight or obesity): Being overweight or obese increases the risk of both NAFLD and NASH. Extra fat in the body can end up in the liver.
• Problems using insulin (insulin resistance): Insulin is a hormone that helps your body use sugar from food. If your body doesn't respond properly to insulin, it can't use sugar effectively. This can lead to extra sugar in the blood (high blood sugar) and extra fat in the liver.
• High blood sugar (Type 2 diabetes): Type 2 diabetes is a condition where your body doesn't produce enough insulin or doesn't use it properly. This leads to high blood sugar levels, which can contribute to fat building up in the liver.
• High levels of fats in the blood (high triglycerides): Triglycerides are a type of fat found in the blood. High levels of triglycerides can increase the risk of fat accumulating in the liver.

These factors often work together to increase the chances of developing a fatty liver. However, some people develop NAFLD even without any of these risk factors. This suggests there might be other, unknown factors involved.

Fatty liver disease (NAFLD) can be linked to several health conditions. A family history of fatty liver or being overweight can increase your chances. Other factors include:

• Hormonal imbalances: If your body doesn't produce enough growth hormone (growth hormone deficiency), or if your thyroid or pituitary gland isn't working properly (hypothyroidism or hypopituitarism), you might be more prone to NAFLD.

• High blood fats: Having high cholesterol or triglycerides (a type of fat in your blood) can contribute to fatty liver.

• Insulin resistance and metabolic issues: If your body doesn't use insulin effectively (insulin resistance) or you have metabolic syndrome (a cluster of health problems including high blood pressure, high blood sugar, and excess belly fat), your risk of NAFLD goes up.

• Weight issues: Being overweight, particularly if you carry extra weight around your midsection, significantly increases your risk. Obesity itself is a major risk factor.

• Other conditions: Polycystic ovary syndrome (PCOS) and obstructive sleep apnea can also be linked to NAFLD. Type 2 diabetes is a strong risk factor.

Certain groups are also more likely to have a type of NAFLD called NASH (non-alcoholic steatohepatitis), a more serious form of the disease:

• Age: People over 50 are at higher risk.

• Genetics: Some people have a genetic predisposition to NASH.

• Existing conditions: Having obesity, diabetes, or high blood sugar increases the risk of NASH. If you have symptoms of metabolic syndrome, such as high blood pressure, high triglycerides, or a large waist size, you're also at higher risk.

Important Note: It's difficult to tell the difference between NAFLD and NASH without a proper medical examination and tests by a doctor. If you have concerns, it's essential to see a healthcare professional.

A healthy liver looks smooth and normal. A diseased liver, with cirrhosis, has areas of scar tissue replacing healthy liver tissue. This scarring makes the liver look rough.

Enlarged veins in the food pipe (esophagus) are called esophageal varices. These often happen when blood flow to the liver is blocked. Normally, blood from the intestines travels to the liver through a vein called the portal vein. When this flow is blocked, blood backs up, putting pressure on the veins in the esophagus, making them swell.

Liver cancer starts in the liver's own cells. The most common type, called hepatocellular carcinoma, begins in special liver cells called hepatocytes.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are conditions that can lead to serious liver problems, including a lot of scarring. NASH, in particular, involves liver inflammation. When the liver is inflamed, it tries to heal itself. This healing process causes areas of scar tissue, or fibrosis, to form. If the inflammation continues, more and more of the liver is replaced by scar tissue.

If liver scarring (cirrhosis) isn't treated, it can lead to several problems:

• Fluid buildup in the belly: This is called ascites.
• Swollen veins in the food pipe (esophagus): These swollen veins are called esophageal varices. They can burst and bleed, which is very dangerous.
• Brain problems: Cirrhosis can cause confusion, drowsiness, and trouble speaking clearly, known as hepatic encephalopathy.
• Overactive spleen: This can lead to a low number of blood platelets, making it harder for the blood to clot.
• Liver cancer: Scarring increases the risk of liver cancer.
• Liver failure: Eventually, the liver may stop working entirely.

In the United States, about a quarter of adults have NAFLD, and between 1.5% and 6.5% have NASH. These numbers show how common these conditions are.

Preventing Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD is a common liver condition where fat builds up in the liver. Here's how you can lower your chances of developing it:

1. Eat a Nutritious Diet: Focus on foods that are good for your overall health. This means plenty of:

• Fruits: Apples, bananas, berries, oranges – all are packed with vitamins and fiber.
• Vegetables: Broccoli, carrots, spinach, and tomatoes provide essential nutrients and fiber.
• Whole Grains: Brown rice, whole wheat bread, and oats offer complex carbohydrates, fiber, and important vitamins.
• Healthy Fats: Avocados, nuts, and olive oil are good sources of healthy fats that support overall health.

2. Control Your Intake of Unhealthy Foods and Drinks:

• Limit Sugary Foods and Drinks: Avoid or cut back on sugary sodas, sports drinks, juices, and sweet tea. These drinks quickly add excess sugar to your diet. Also, be mindful of sweets and desserts.
• Portion Control: Even healthy foods can cause problems if you eat too much. Pay attention to how much you're eating and try to eat smaller portions.
• Alcohol: Alcohol can significantly damage your liver. If you drink alcohol, do so in moderation, or avoid it completely.

3. Maintain a Healthy Weight:

• Overweight or Obese: If you are overweight or obese, it's crucial to work with your doctor or a registered dietitian to safely and gradually lose weight.
• Healthy Weight: If you're at a healthy weight, focus on keeping it that way. This means maintaining a nutritious diet and getting regular exercise.

4. Be Physically Active:

• Regular Exercise: Aim to be active most days of the week. This could be anything from brisk walking to swimming to dancing.
• Start Slowly: If you haven't been exercising regularly, talk to your doctor first before starting a new exercise routine. They can help you develop a safe and effective plan.

By following these steps, you can significantly reduce your risk of developing NAFLD and keep your liver healthy. Remember, consistency is key. Making small, healthy changes to your lifestyle over time can have a big impact on your long-term health.

Nonalcoholic Fatty Liver Disease (NAFLD) often has no noticeable symptoms, meaning it's frequently discovered during routine medical tests for other reasons. For example, a blood test for something else might show high liver enzyme levels, triggering further investigations and a NAFLD diagnosis.

How Doctors Diagnose NAFLD:

Doctors use a combination of tests to diagnose NAFLD, rule out other liver conditions, and assess the severity of any liver damage. These tests include:

• Blood Tests: These are crucial for evaluating liver health.

  • Complete Blood Count (CBC): Checks the overall health of your blood.
  • Iron Studies: Measures iron levels in your blood and cells.
  • Liver Enzyme and Function Tests: Look for signs of liver damage.
  • Tests for Viral Hepatitis (like Hepatitis C): Rules out infections.
  • Celiac Disease Screening: Identifies potential issues with the digestive system.
  • Fasting Blood Sugar: Checks for diabetes or pre-diabetes.
  • Hemoglobin A1C: Shows your average blood sugar levels over several months.
  • Lipid Profile: Measures fats in your blood, including cholesterol and triglycerides.

• Imaging Procedures: These tests help visualize the liver.

  • Abdominal Ultrasound: A common first test to check for liver problems. It uses sound waves to create an image.
  • Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) Scan: These provide detailed images of the liver. They are good at detecting mild scarring (fibrosis), but can't distinguish between simple fatty liver (NAFLD) and more serious liver damage (NASH).
  • Transient Elastography: A type of ultrasound that measures how stiff the liver is. Liver stiffness often indicates scarring.
  • Magnetic Resonance Elastography (MRE): Combines MRI and sound waves to create a visual map of liver stiffness.

• Liver Biopsy: If other tests suggest more advanced liver disease or NASH, or if results are unclear, a liver biopsy might be necessary.

  • Procedure: A small piece of liver tissue is removed using a needle inserted through the abdomen.
  • Purpose: The removed tissue is examined under a microscope to look for inflammation and scarring.
  • Benefits: A liver biopsy is the definitive way to diagnose NASH and assess the extent of liver damage.
  • Risks: A liver biopsy can be uncomfortable and has some risks, which your doctor will discuss in detail.

Important Note: All these tests work together to give a complete picture of your liver health. Your doctor will choose the appropriate tests based on your individual situation and medical history. A care team of specialists can help you understand your diagnosis and treatment options.

Non-alcoholic fatty liver disease (NAFLD) treatment often starts with losing weight. This means eating healthier foods, controlling portion sizes, and getting regular exercise. Losing weight can help improve other health problems that might be contributing to NAFLD. It's generally recommended to lose at least 10% of your body weight, but even losing 3% to 5% can offer benefits.

For some people, weight-loss surgery or medications might also be helpful.

A new medication, resmetirom (Rezdiffra), is available to treat people with NAFLD that has progressed to NASH (non-alcoholic steatohepatitis) with moderate to severe liver scarring. This medicine helps reduce the amount of fat in the liver. However, it's not suitable for people with cirrhosis (severe liver damage).

If someone has cirrhosis caused by NASH, a liver transplant might be necessary.

If you have concerns about NAFLD, please talk to your doctor. They can help determine the best treatment plan for you.