Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is a buildup of excess fat in the liver of people who drink little or no alcohol. The most common form of NAFLD is a non-serious condition called fatty liver. In fatty liver, fat collects in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver. A small group of individuals with NAFLD may have a more serious condition named non-alcoholic steatohepatitis (NASH). In NASH, the fat buildup is linked to liver cell inflammation and eventual increasing levels of scarring. NASH is a potentially severe condition that may lead to advanced liver scarring called cirrhosis. At its most severe, nonalcoholic fatty liver disease can progress to liver failure or liver cancer.
NAFLD is part of the metabolic syndrome categorized by diabetes, or pre-diabetes (insulin resistance), being overweight or obese, elevated blood lipids such as cholesterol and triglycerides, as well as high blood pressure. Not all patients have all the indicators of the metabolic syndrome. Not much is known about how NASH develops or its cause. Researchers are focusing on several factors that may contribute to the development of NAFLD/NASH. These include:
- Oxidative stress (imbalance between pro-oxidant and anti-oxidant chemicals that lead to liver cell damage)
- Production and release of toxic inflammatory proteins (cytokines) by the patient’s own inflammatory cells, liver cells, or fat cells
- Liver cell necrosis or death, called apoptosis
- Adipose tissue (fat tissue) inflammation and infiltration by white blood cells
- Gut microbiota (intestinal bacteria) which may play a role in liver inflammation
- Weight Loss
- Viral Hepatitis
- Auto Immune or Inherited Liver Disease
NAFLD is a very common disorders which effects as many as one in three to one in five adults and around one in ten children in the United States. Obesity is thought to be the most common cause of fatty infiltration of the liver. In addition, the presence of type 2 diabetes and other conditions associated with insulin resistance, such as polycystic ovarian syndrome are know risk factors for the development of fatty liver and NASH. Fatty liver, even when it isn’t hurting the liver, is an indicator of unhealthy metabolism and in the longrun means a much higher risk of serious cardiovascular disease, strokes, kidney disease and of type II diabetes. Fatty liver then is often an ALARM SIGNAL.
Signs & Symptoms
Fatty Liver disease causes little to no signs or symptoms in most cases. When NAFLD does cause signs and symptoms they include:
- Pain in upper right abdomen, commonly a persisten and intermittent dull aching
- Bloat or fullness in the abdomen related to accumulations of fat generally inside the abdomen (visceral fat)
Screenings & Diagnostic Tests
To determine if you or a loved one may have NAFLD, some tests and procedures can be used to diagnose your condition. They include:
- Blood Tests - The diagnosis of NAFLD is usually first suspected in an overweight or obese person who is found to have mild elevations in their liver “enzyme tests” (ALT, AST) in routine blood testing. Some experts are now recommending that every obese child or adolescent should have these liver enzymes tested.
- Imaging Procedures - Imaging procedures used to diagnose fatty liver disease are mainly ultrasound, seldom computerized tomography (CT) scan or magnetic resonance imaging (MRI). A newer test called Fibroscan (liver elastography) is sometimes used to detect if scar tissue is present.
- Liver Tissue Testing - the only reliable way of telling whether a person has NASH or simple fatty liver is by a liver biopsy. In this procedure, a small needle is inserted through the skin after local anesthesia is given to obtain a small piece of the liver for microscopic evaluation. NASH is diagnosed when examination of this piece of liver under the microscope shows fatty infiltration of the liver in addition to inflammation and different degrees of scarring. If only fat is present, then the diagnosis of simple fatty liver is made. The liver biopsy provides essential information regarding the degree of scarring within the liver, which would not be apparent on a blood test, ultrasound, or an x-ray alone.
Since fatty liver and NASH are caused by diet and weight gain, aggravated by lack of exercise, the only known effective treatments involve healthier diet and healthier levels of exercise. Sometimes alcohol must be cut back or stopped. Treatment of associated conditions like high cholesterol (hyperlipidemia) and treatment of diabetes also helps the fatty liver. There is no standard medication for these liver conditions. Better diet and exercise, even if weight loss does NOT occur, still can improve the condition. Remember, the liver isn’t the most important target of the bad metabolism: it is your heart and your arteries and your pancreas (diabetes). Research is being done to find effective treatments for NASH since it can cause cirrhosis and increase the risk of liver cancer.
Lifestyle and Home Remedies
Doctors state that those with a non-alcoholic fatty liver disease can control and reduce the chance of complications by:
- Losing weight
- Choosing a healthy diet (low carb and low fructose)
- Exercising regularly
- Controlling diabetes as well as possible
- Lowering cholesterol if you have heart risk factors
- Protecting your liver (prudent alcohol; drinking coffee actually is protective)