Nonalcoholic Fatty Liver Disease (NAFLD)

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NAFLD is the accumulation of fatty substances in the liver not caused by alcohol. Symptoms are often not visible but can include weakness fatigue, itchy skin, etc. Treatments can be medications and diet to manage the condition.

The liver is one of the most important organs in the body when it has to do with metabolism processes that take place in the body. Its role in the body is very vital as it aids in digestion, stores energy, and eliminating toxic waste from the body.  A healthy liver should no little or no fat.

WHAT IS NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)?

Nonalcoholic fatty liver disease occurs when there are fatty substances that have assimilated in the liver but do not have an alcoholic cause. Nonalcoholic fatty liver disease can lead to hepatic steatosis when up to 10% of the liver’s weight is fat.

Nonalcoholic fatty liver disease is used to describe a range of conditions due to the build-up of fatty substances in the liver. Most obese or overweight people stands at risk of developing NAFLD. An estimate of 1 in every 3 persons has small amounts of fat in their liver and about 25% of the world population are affected.

STAGES OF NONALCOHOLIC FATTY LIVER DISEASE(NAFLD)

There are several stages of NAFLD namely:

  • Simple Fatty Liver 

This occurs when there is fat in the liver but little or no inflammation or liver cell damage. It does not cover complications.

  • Nonalcoholic Steatohepatitis 

Here, both fatty tissues and inflammation of liver cells occur and much damage is done to the liver. This inflammation can cause fibrosis or scarring in the liver which could lead to cancer of the liver.

  • Fibrosis

This occurs when continuous inflammation leads to scarring tissue around the liver and its blood supply.

  • Cirrhosis 

This is a very severe stage. Here, the liver cells shrink and start scarring creating permanent damage and lead to liver failure. It takes time for the liver to get to this level.

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Nonalcoholic Fatty Liver Disease (NAFLD)

What do you mean by non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease (NAFLD) is a condition characterized by the accumulation of fat in the liver cells (hepatocytes), affecting people who consume little or no alcohol. Most of the people diagnosed with NAFLD are asymptomatic.

The largest organ of the body is the liver. It is located in the right upper part of the abdomen below the ribs. The liver’s main function is to act as a blood filter and metabolizes nutrients, proteins, drugs, and other substances in the body. The liver is susceptible to damage from various sources such as infections (viral, bacterial), toxins (alcohol consumption, drug overload, unhealthy lifestyle), inherited (hereditary) conditions, or even our immune system.

Nonalcoholic Fatty Liver Disease
Picture Courtesy: hunterdongastro

What are the types of NAFLD?

types of NAFLD
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There are two types of NAFLD. They are:

  1. Non-alcoholic fatty liver (NAFL)
  2. Non-alcoholic steatohepatitis (NASH)- It is considered to be the most severe form of NAFLD.

Causes and risk factors of NAFLD

causes and risk factors of NAFLD
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The exact cause of NAFLD is not known (idiopathic). In comparison, few risk factors might cause non-alcoholic fatty liver disease. They are listed below:

  • Obesity or overweight
  • Patients who have developed insulin resistance, in which the cells don’t take up sugar in response to the insulin hormone.
  • High levels of cholesterol, particularly high levels of LDL level triglyceride levels in the blood.
  • Underactive thyroid (hypothyroidism)
  • Metabolic syndrome
  • Underactive pituitary gland (hypopituitarism)

Symptoms

symptoms of NAFLD
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Initially, symptoms may not be visible. The symptoms of NAFLD include:

  • Dull or acute pain at the right side of the abdomen. 
  • Easily fatigued 
  • Drastic weight loss
  • Weakness
  • Jaundice
  • Itchy skin
  • Edema; swelling at the ankles

How is non-alcoholic fatty liver disease diagnosed?

DIAGNOSIS OF NAFLD
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The diagnosis of NAFLD is difficult since most of the patients diagnosed with NAFLD are asymptomatic at their early stage. The doctor will advise the patient to undergo several tests to confirm the disease. They are listed below:

  • Physical examination- During the physical examination, the doctor will palpate (touch) the abdomen to look for any signs of abnormalities.
  • Laboratory tests- They include complete blood count, liver function test (to check the levels of liver enzymes), kidney function test, lipid profile, HbA1c (sugar test), and celiac disease screening test.
  • Tests for chronic viral hepatitis (A, B, C)
  • Investigational scans- They include ultrasonography of the abdomen, CT scans, etc.
  • Liver Biopsy It determines how advanced the liver disease has progressed. During this procedure, a small sample of liver tissue is taken out and sent for pathological studies.
  • Transient elastography- This test is performed to enhance the stiffness of the liver. Liver stiffness indicates liver fibrosis or scarring.

How is NAFLD treated?

The early stages of NAFLD may not have serious complications as the liver cells are yet to be affected, but it can pose serious issues later if not managed effectively.

Currently, there is no specific medication, but a healthy way of life could effectively manage it.

  • The patient will be treated for any underlying associated condition such as high blood pressure, diabetes, high cholesterol, etc.
  • Medications will be given to help manage the condition and associated conditions.
  • A liver transplant could be carried out if the liver is severely damaged. This could be just a part of the entire liver.

For management, keep to the following guidelines:

  • Regular exercise will be advised to lose weight.
  • Avoid smoking.
  • Eating a balanced diet can help.
  • Although NAFLD is not caused by drinking alcohol, it is still advisable to avoid alcohol drinking, as it can worsen the condition.
  • Vitamin E can also help.
  • Weight loss will be advised.

Can NAFLD be prevented?

prevention of nafld
Picture Courtesy: pathlabs

Preventive measures include:

  • Maintain a healthy meal
  • Exercising regularly
  • Control the diabetes
  • Protect the liver from other toxic substances
  • Take medications as prescribed
  • Get vaccinated against hepatitis A, B, pneumococcal diseases, and flu.
  • Avoid obesity and high cholesterol intake.

FAQ

Does NAFLD cause elevated liver enzymes?

Nonalcoholic fatty liver disease is one of the common causes of elevated liver enzymes, especially in people with infectious hepatitis.

How can I protect my liver?

The liver can be protected by taking measures such as preventing overweight, maintaining healthy diets, increasing physical activities and exercises, reducing cholesterol intake, reducing or avoiding alcohol intake, avoiding smoking, etc.

Which diet is the best for NAFLD?

Fruits such as berries, grapes, garlic, grapefruit, prickly pear, nuts, olive oil, fish, etc., could produce a healthy effect on the liver. Avoid foods and drinks rich in simple sugars.

Can you reverse NAFLD?

NAFLD does not need any special medication if there are no associated conditions. Adjustment and healthy living can control and reverse the fatty build-up in the liver.

Is egg good for NAFLD?

Recent studies have shown that the increase in consumption of eggs daily could lead to NAFLD, although it might be affected by factors such as age, gender, alcohol consumption, etc.

What are the complications associated with NAFLD?

The complications associated with non-alcoholic fatty liver disease are listed below:
1)      Ascites (accumulation of fluid in the abdomen)
2)      Esophageal varices (swelling of the veins in the esophagus) which can rupture and bleed.
3)      Hepatic encephalopathy (confusion, drowsiness, and slurred speech)
4)      Liver cancer
5)      Liver cirrhosis, end-stage liver failure.

What are the stages of liver damage?

The stages of liver cancer are described below.
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Can fatty liver disease be fatal?

Early diagnosis and treatment of fatty liver disease will have a good prognosis. While if left untreated, it can become a more serious problem such as cirrhosis of the liver. Untreated liver cirrhosis eventually leads to liver failure or liver cancer which can be fatal.

Can non-alcoholic fatty liver disease be inherited (hereditary)?

There is a possibility that non-alcoholic fatty liver disease can be inherited [1,2].

What medications can cause non-alcoholic fatty liver disease?

The medications which can cause NAFLD are: corticosteroids, anti-depressants, antipsychotic medications, tamoxifen, cisplatin, etc.

References

  1.  Brunt EM, Wong VW, Nobili V, Day CP, Sookoian S, Maher JJ, et al. Nonalcoholic fatty liver disease. Nat Rev Dis Primers. 2015; 1:15080. [PubMed] [Google Scholar]
  2. Sookoian S, Pirola CJ. The genetic epidemiology of nonalcoholic fatty liver disease: toward a personalized medicine. Clin Liver Dis. 2012; 16:467–485. [PubMed] [Google Scholar]