Nonalcoholic Fatty Liver Disease
Introduction
Nonalcoholic Fatty Liver Disease (NAFLD) is a common liver disorder characterized by the accumulation of excess fat in liver cells, occurring in individuals who consume little to no alcohol.
It is considered a spectrum of conditions ranging from simple fatty liver (steatosis) to a more severe form known as Nonalcoholic Steatohepatitis (NASH), which can lead to liver inflammation, fibrosis, and potentially progress to cirrhosis or liver cancer.
People who drink little to no alcohol are susceptible to nonalcoholic fatty liver disease, or NAFLD. An excessive amount of fat accumulates in the liver in NAFLD. People who are overweight or obese are most likely to experience it.
As the number of obese people increases, NAFLD is becoming increasingly prevalent, particularly in Western and Middle Eastern countries. It is the most prevalent type of liver disease worldwide. Hepatic steatosis, also known as fatty liver, and nonalcoholic steatohepatitis (NASH), a more severe type of disease, are the two extremes of NAFLD severity.
Because of the fat accumulation in the liver, NASH makes the liver enlarge and destroy it. As NASH worsens, it can result in cirrhosis, a severe form of liver scarring, and even liver cancer. This harm is comparable to the harm brought on by excessive alcohol consumption.
The term nonalcoholic fatty liver disease is being considered for renaming to metabolic dysfunction-associated steatosis liver disease (MASLD). The term “nonalcoholic steatohepatitis” should be changed to “metabolic dysfunction-associated steatohepatitis” (MASH), according to experts.
Excess fat accumulates in the liver in nonalcoholic fatty liver disease, or NAFLD (also known as metabolic dysfunction-associated steatosis liver disease, or MASLD). Heavy drinking is not the cause of this fat accumulation. Alcohol-associated liver disease occurs when excessive alcohol use results in the accumulation of fat in the liver.
Nonalcoholic fatty liver, or NAFL (also known as metabolic dysfunction-associated steatosis liver, or MASL), and nonalcoholic steatohepatitis, or NASH (also known as metabolic dysfunction-associated steatohepatitis, or MASH), are the two forms of nonalcoholic fatty liver disease (NAFL). Although persons with one form of NAFLD may later be diagnosed with the other kind, people usually develop one or the other type of NAFLD.
The NAFL
A type of NAFLD known as NAFL occurs when there is liver fat but little to no inflammation or damage to the liver. Usually, NAFL does not worsen to the point of causing problems or liver damage. However, because NAFL enlarges the liver, it might cause pain.
NASH
The kind of NAFLD known as NASH is characterized by liver damage and inflammation in addition to liver fat. Liver fibrosis, or scarring, can result from NASH’s inflammation and liver damage. Cirrhosis, in which the liver is permanently damaged and scarred, can result from NASH. Liver cancer can result from cirrhosis.
The reason why some NAFLD patients have NASH and others have NAFL is unknown to experts.
How widespread is NAFLD?
One of the most prevalent forms of liver disease in the US is nonalcoholic fatty liver disease (NAFLD). NAFL is present in most NAFLD patients. NASH is seen in just a tiny percentage of NAFLD patients. According to experts, 1.5% to 6.5% of American adults suffer from NASH, and 24% of adults in the country have NAFLD.
Who has a higher risk of developing NAFLD?
People with obesity and disorders that may be linked to obesity, like type 2 diabetes, are more likely to have non-alcoholic fatty liver disease (NAFLD). According to studies, NAFLD affects one-third to two-thirds of individuals with type 2 diabetes. Additionally, studies indicate that up to 75% of overweight individuals and over 90% of severely obese individuals have NAFLD.
Children and adults of all ages can be affected by NAFLD. According to research, NAFLD affects over 10% of children in the United States between the ages of 2 and 19. However, as people age, their risk of developing NAFLD increases.
Although NAFLD can affect persons of any race or ethnicity, Hispanic people are the most likely to have it, followed by non-Hispanic white people and Asian Americans, particularly those of East Asian and South Asian heritage. The prevalence of NAFLD is lower among non-Hispanic Black people. Compared to non-Hispanic whites with NAFLD, Asian Americans with NAFLD typically have lower BMIs Some of the racial and ethnic disparities in NAFLD may be explained by genes, according to experts.
Signs and symptoms
Often, NAFLD shows no signs. When it does, these could consist of:
- Exhaustion.
- Malaise is the term for not feeling well.
- Soreness or discomfort in the upper right abdominal region.
The following are possible signs of cirrhosis or severe scarring, and NASH:
- Skin that itches.
- Another name for abdominal swelling is ascites (pronounced “uh-SY-tees”).
- Breathlessness.
- The legs getting bigger.
- Blood arteries that resemble spiders and are located immediately beneath the skin.
- Enlarged spleen.
- Palms of red.
- Skin and eye yellowing is called jaundice.
Reasons
The precise reason why fat accumulates in certain livers but not in others is unknown to experts. Additionally, they are not entirely sure why some fatty livers develop NASH.
Both NASH and NAFLD are associated with the following:
- Genetics.
- Obesity.
- Insulin resistance is the result of your cells’ inability to absorb sugar in response to the insulin hormone.
- Type 2 diabetes is also referred to as hyperglycemia or elevated blood sugar.
- Elevated blood fat levels, particularly triglycerides.
- A fatty liver may be caused by these several health issues. But even without any risk factors, some people develop NAFLD.
Nonalcoholic fatty liver disease (NAFLD) stages

NAFLD progresses via four major phases.
The majority of people only ever experience the first stage, and they typically aren’t aware of it.
If not identified and treated, it may worsen in a few instances and ultimately result in liver damage.
NAFLD’s primary stages are:
Simple fatty liver, also known as steatosis, is a generally innocuous accumulation of fat in the liver cells that can only be identified by tests performed for other purposes.
The liver has developed inflammatory fibrosis in non-alcoholic steatohepatitis (NASH), a more severe form of NAFLD. Persistent inflammation results in scar tissue around the liver and surrounding blood vessels, but the liver can still function normally.
After years of inflammation, the liver shrinks and becomes lumpy and scarred in cirrhosis, the most severe stage. This damage is irreversible and can result in liver failure, where your liver stops functioning normally, and liver cancer.
The development of cirrhosis or fibrosis may take years. Lifestyle changes are crucial to halting the progression of the illness.
Problems with the liver
Although they are more likely to experience other health issues, those with NAFL usually do not experience liver consequences.
Liver problems like cirrhosis and liver cancer can occur in people with NASH. You might require a liver transplant if cirrhosis causes liver failure. The risk of dying from liver-related causes is higher in people with NASH.
- Additional health issues
- NAFLD patients are more likely to experience specific health issues, such as
The most frequent cause of mortality for individuals with NAFLD5 type 2 diabetes metabolic syndrome, cardiovascular disease, and other illnesses that may be associated with metabolic syndrome include high blood pressure and abnormal blood fat levels, including triglycerides and cholesterol.
Risk elements
Your chance of developing NAFLD can be raised by several illnesses and conditions, such as:
- Obesity or fatty liver disease in the family.
- The body doesn’t produce enough growth hormones when there is a growth hormone shortage.
- High cholesterol
- Elevated blood triglyceride levels.
- Insulin resistance.
- Metabolic syndrome.
- Obesity, particularly if the excess fat is concentrated around the waist.
- Syndrome of polycystic ovaries.
- Apnea due to obstruction in sleep.
- Diabetes type 2.
- Hypothyroidism is another name for an underactive thyroid.
- Hypopituitarism, or an underactive pituitary gland.
These groups are more prone to have NASH:
- Individuals above 50.
- Individuals who have certain genetic risk factors.
- Those who are obese.
- Those who have high blood sugar or diabetes.
- Individuals who have high blood pressure, high triglycerides, and a big waist as signs of metabolic syndrome.
- Without a clinical assessment and testing, it is difficult to distinguish between NASH and NAFLD.
Does non-alcoholic fatty liver disease (NAFLD) pose a risk to me?
NAFLD is more likely to occur if you:
- Are overweight or obese, especially if you have an “apple-like” body shape with a lot of fat around your waist?
- Have polycystic ovarian syndrome type 2 diabetes, or a disorder called insulin resistance that alters how your body uses insulin.
- Keep your blood pressure up and your thyroid underactive.
- Possess elevated cholesterol and metabolic syndrome, which is a confluence of obesity, high blood pressure, and diabetes.
- Are smokers who are above 50?
However, NAFLD has been identified in individuals, including young children, who do not have any of these risk factors.
NAFLD is not brought on by excessive alcohol consumption, even though it closely resembles alcohol-related liver disease (ARLD).
Making a diagnosis
To diagnose nonalcoholic fatty liver disease (NAFLD), doctors look at your medical history, perform a physical examination, and run tests. To diagnose nonalcoholic fatty liver disease (NAFL) and distinguish it from nonalcoholic steatohepatitis (NASH), doctors may employ imaging studies, liver biopsies, and blood testing.
After other liver disorders, such as hepatitis, have been ruled out and a blood test known as a liver function test yields an abnormal result, NAFLD is frequently diagnosed.
NAFLD is frequently discovered when tests performed for other reasons indicate a liver issue because it usually doesn’t create any symptoms. High levels of liver enzymes, for instance, may be seen in a blood test performed during an annual physical, prompting additional testing and a diagnosis of nonalcoholic fatty liver disease.
The tests listed below are used to determine the extent of liver damage, rule out other conditions, and diagnose NAFLD:
Blood examinations
- Whole blood count.
- The amount of iron in your blood and other cells is shown by iron investigations.
- Testing for liver function and liver enzymes.
- Tests for hepatitis A, hepatitis C, and other chronic viral hepatitis.
- Screening test for celiac disease.
- Blood sugar levels during a fast.
- Your blood sugar stability is indicated by your hemoglobin A1C level.
- Lipid profile, which quantifies triglycerides and cholesterol in the blood.
Imaging techniques
The following imaging tests are used to diagnose NAFLD:
- When liver disease is suspected, abdominal ultrasonography is frequently the first test performed.
- Scanning using computerized tomography (CT) or magnetic resonance imaging (MRI). These tests cannot distinguish between NASH and NAFLD, although they are more effective at detecting mild liver fibrosis.
- A more recent form of ultrasound that gauges your liver’s stiffness is called transient elastography. Liver stiffness indicates scarring or fibrosis.
- MRI imaging and sound waves are combined in magnetic resonance elastography (MRI) to produce an electrogram, or visual map, that illustrates the stiffness of bodily tissues.
An ultrasound scan of your abdomen may also reveal the issue.
With this kind of scan, an internal body image is produced using sound waves.
To find out the stage you have of NAFLD, additional testing could be required after a diagnosis. This could entail undergoing a different kind of ultrasound scan (Fibro scan) or a particular blood test.
A biopsy, which involves taking a little sample of liver tissue with a needle so that it can be examined in a lab, may also be necessary for certain people.
Every three years, children and adolescents with type 2 diabetes or metabolic syndrome who are at a higher risk of developing nonalcoholic fatty liver disease (NAFLD) should have a liver ultrasound.
You might also get an MRI or CT scan as further tests.
Biopsy of the liver
Your doctor can recommend a liver biopsy if additional testing reveals indications of more severe liver disease or NASH, or if the results of your tests are not clear. The process of removing a little sample of liver tissue is called a liver biopsy. Usually, a needle is inserted via the abdominal wall. In a lab, the tissue sample is examined for indications of scarring and inflammation. The most accurate method of diagnosing NASH is liver biopsy, which also makes the extent of liver damage evident.
Your healthcare team will thoroughly discuss the risks and potential discomfort of a liver biopsy with you. A needle is used for this technique, which involves passing it through the abdominal wall and into the liver.
Complication
Cirrhosis, or severe liver scarring, is the primary consequence of NAFLD and NASH. Liver injury, such as the inflammation-induced damage in NASH, is the cause of cirrhosis. The liver produces fibrosis, or patches of scarring, in an attempt to reduce inflammation. As inflammation persists, fibrosis expands and enlarges the liver.
If the scarring is not stopped, cirrhosis can result in:
- Ascites is the term for fluid accumulation in the stomach region.
- Esophageal varices are enlarged veins in the esophagus that have the potential to burst and bleed.
- Another name for hepatic encephalopathy is slurred speech, confusion, and drowsiness.
- Too few blood platelets can result from hypersplenism or an overworked spleen.
- Carcinoma of the liver.
- End-stage liver failure is a condition in which the liver is no longer functional.
Therapy
To treat nonalcoholic fatty liver disease (NAFLD), also known as nonalcoholic steatohepatitis (NASH) or nonalcoholic fatty liver disease (NAFL), doctors advise losing weight. Losing weight can lessen liver fibrosis, inflammation, and fat. There are currently no approved medications to treat NASH or NAFLD.
Although the majority of people with NAFLD do not experience any significant issues, it is wise to take action to prevent further deterioration if you have been diagnosed with the condition.
Although there isn’t a specific treatment for NAFLD at the moment, adopting a healthy lifestyle can be beneficial.
Complications or related illnesses (such as high blood pressure, diabetes, and cholesterol) may also require treatment.
To monitor your liver function and search for any new issues, your doctor could recommend that you schedule routine checkups.
Although there isn’t a medication that can cure NAFLD at this time, there are several medications that can help manage its symptoms.
For instance, your doctor might prescribe medication to address obesity, type 2 diabetes, high blood pressure, and high cholesterol.
Researchers are looking into many possible treatments for NASH, but there are currently no licensed drugs to treat NAFLD, which includes NASH. Because many herbal medicines may cause or exacerbate liver damage, the National Institutes of Health advises persons with fatty livers to see a doctor before beginning any alternative treatments or dietary supplements.
Weight loss, which can occasionally be accomplished with a balanced diet and consistent exercise, may be beneficial for those who are overweight. Liver fat deposits can be reduced by losing at least 3% to 5% of body weight, while liver inflammation and scar tissue can be decreased by losing 7% to 10%.
Your doctor may suggest medication, minor medical treatments, or liver transplant surgery to treat cirrhosis complications if you have both NASH and cirrhosis.
If you are overweight, you should lose weight.
- Consuming a nutritious, salt-free diet.
- Avoiding booze.
- Maintaining an active lifestyle.
- Taking care of illnesses like diabetes and hypertension.
- Receiving vaccinations against illnesses like hepatitis A and hepatitis B.
- Reducing your triglyceride and cholesterol levels.
- Taking medications as prescribed. Discuss all of your medications with your doctor, including over-the-counter medications, vitamins, and herbs.
- The accumulation of fat in the liver can be slowed or even reversed by controlling diabetes and losing weight.
Nutrition, Diet, and Eating
Eating a nutritious diet and keeping a healthy weight may help you avoid nonalcoholic fatty liver disease (NAFLD), also known as nonalcoholic steatohepatitis (NASH) or nonalcoholic fatty liver disease (NAFL). Your doctor could advise diet modifications and weight loss if you have non-alcoholic fatty liver disease.
What to do if you have NAFLD (non-alcoholic fatty liver disease)
The primary strategy for managing NAFLD is to adopt a healthy lifestyle.
For instance, it can assist in:
- Reduce weight: If you have NASH, decreasing more than 10% of your body weight can help eliminate some of the fat from your liver. Aim for a BMI of 18.5 to 24.9 (calculate your BMI using the BMI calculator).
- Consume a balanced diet that is heavy in fruits, vegetables, protein, and carbs but low in fat, sugar, and salt. Eating smaller portions of food can also be beneficial.
Drink water instead of sugary beverages.
- Regular exercise, even if you don’t lose weight, can help improve NAFLD. Try to get in at least 150 minutes a week of moderate-intensity activity, including walking or cycling.
- Quitting smoking can help lower your risk of issues like heart attacks and strokes if you currently smoke.
- Although alcohol does not cause NAFLD, it may exacerbate it. Therefore, reducing or quitting alcohol consumption is advised.
Avoidance
To lower your chance of developing NAFLD:
- Consume a nutritious diet. Consume a diet high in whole grains, fruits, veggies, and good fats.
- Limit portion sizes, alcohol, and simple sweets. Steer clear of sugar-filled beverages such as soda, sports drinks, juices, and sweet tea. Alcohol use should be restricted or avoided since it can harm your liver.
- Maintain a healthy weight. Work with your medical team to lose weight gradually if you are overweight or obese. Maintain your healthy weight by exercising and eating a balanced diet.
- Work out. On most days of the week, be active. If you have not been exercising regularly, first get your healthcare team’s approval.
Effects of NASH Worldwide
Globally, both in developed and developing nations, NAFLD is on the rise. It is anticipated that 48.26 million Chinese will have NASH by 2030. Spain had 1.8 million instances in 2016, and by 2030, that number is predicted to rise by 49%. In 2016, there were 3.33 million NASH cases in Germany; by 2030, that number is expected to increase by 43%. Additionally, by 2030, studies predict that there will be 27 million NASH cases in the US.
An increase in NASH cases can have a severe financial impact on patients and their families, payers, and governments in addition to having a detrimental effect on lives.
Prospects (Prognosis)
Many NAFLD patients do not develop NASH and have no other health issues. Making good lifestyle choices and losing weight can help avert more serious issues.
Why some people get NASH is unknown. Cirrhosis can result from NASH.
FAQs
Can fatty liver be cured?
It can result in liver failure and cirrhosis, among other much more serious disorders. The good news is that if patients take steps, such as maintaining a 10% weight loss, fatty liver disease can be reversed and even cured.
How can liver fat be eliminated?
Fatty liver disease prevention and reversal
Safely reduce weight.
Reduce your triglycerides by taking medicine, eating less, or both.
Steer clear of booze.
If you have diabetes, manage it.
Eat a healthy, well-balanced diet.
Get more exercise.
See a physician who specializes in liver care for routine examinations.
Can someone with a fatty liver live a long life?
Although patients with NAFLD can live for many years, about 30% of them eventually develop scarring and an inflamed liver, often known as non-alcoholic steatohepatitis (NASH). About 20% of them will progress to end-stage cirrhosis, which can result in cancer and liver failure.
Is fatty liver completely curable?
Fortunately, NAFL and NASH can be reversed. However, fatty liver cannot be reversed after it has developed into cirrhosis or liver cancer. For this reason, it’s critical to alter one’s lifestyle and take early action to treat fatty liver.
What is the treatment for fatty liver disease?
Eat a balanced diet and stay away from sugar.
Reduce your weight.
Engage in regular exercise.
Manage your blood sugar levels.
If you have high cholesterol, take care of it.
Steer clear of medications that may impact your liver.
Give up smoking and consume very little or no alcohol.
Stage 1 fatty liver: what is it?
The hallmark of grade 1 fatty liver is the buildup of fat in the liver cells. With early intervention and lifestyle modifications, it is usually reversible. Alcohol usage, insulin resistance, poor diet, and obesity are among the factors. The symptoms may be mild or nonexistent.
Do bananas help people with fatty livers?
Bananas: Bharadwaj advises patients with fatty liver disease to eat bananas. They include a lot of resistant starch, which is beneficial for liver health, as well as vitamins B6, C, and A. 5. Cranberries: You should include cranberries in your diet, much like blueberries.
How may liver fat be burned?
The amount of fat in your liver could be reduced by even 5% of your body weight. You can reduce inflammation and the likelihood of liver cell damage by losing 7% to 10% of your body weight. You may even be able to undo some of the harm. Take it slow; one to two pounds per week is acceptable.
Reference
- Nonalcoholic fatty liver disease – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567
- Nonalcoholic Fatty Liver Disease (NAFLD) & NASH – NIDDK. (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash
- Definition & Facts of NAFLD & NASH. (2024, December 13). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts
- Website, N. (2024, December 20). Non-alcoholic fatty liver disease (NAFLD). Nhs.uk. https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/
- Nonalcoholic fatty liver disease – Diagnosis and treatment – Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/diagnosis-treatment/drc-20354573
- Pfizer. (n.d.). NASH Overview: Causes, symptoms, diagnosis, and treatment | Pfizer. Pfizer. https://www.pfizer.com/disease-and-conditions/nash
2 Comments