A liver condition in which people drink little or even no alcohol is called nonalcoholic fatty liver disease (NAFLD). This health condition provokes a buildup of fat in the liver and usually occurs in overweight or obese people. The most common NAFLD happens in the Middle Eastern and Western nations because the number of obese people is growing. Nonalcoholic fatty liver disease is the most common liver disease worldwide and it ranges from mild (hepatic steatosis or fatty liver) to severe nonalcoholic steatohepatitis (NASH).
People with NASH usually experience swelling of the liver and damage due to fatty deposits. Without treatment, this condition can lead to scarring of the liver, cirrhosis, and even liver cancer. The damage caused by NASH is very similar to that provoked by heavy alcohol use.
Nowadays, experts recommend changing the name of nonalcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH).
Symptoms
Commonly, people with FAFLD do not have symptoms but when it happens they can experience the following ones. Examples include:
- Generally not feeling well or malaise
- Fatigue (extreme tiredness)
- Pain or discomfort in the upper abdomen
Check below also some symptoms that can happen in people with cirrhosis, NASH, or severe scarring:
- Enlarged spleen
- Jaundice (yellowing of the eyes and skin)
- Red palms
- Spider-like blood vessels on the surface of the skin
- Swelling of the legs or abdomen (ascites)
- Skin itching
If you experience any of the previous symptoms or think you have this liver condition, you should visit a doctor right away.
Causes
Healthcare providers do not fully understand why this condition happens for some people while others do not have it. Therefore, they do not know why fatty livers turn into NASH. Check below some health problems that may increase the risk of NAFLD:
- Type 2 diabetes (also called high blood sugar or hyperglycemia)
- Insulin resistance (it usually occurs when cells do not take sugar in response to insulin hormone)
- High fat levels (especially triglycerides in the blood)
- Genetics
- Overweight or obesity
While a combination of previous factors can provoke fatty liver, other people have this condition without any risks.
Risk Factors
The following health conditions increase the risk of getting NAFLD. Examples include:
- High cholesterol
- Metabolic syndrome
- Insulin resistance
- Polycystic ovary syndrome (PCOS)
- Obesity
- Obstructive sleep apnea (this condition also increases the risk of nightmare disorder)
- Type 2 diabetes
- Hypothyroidism (underactive thyroid gland)
- Hypopituitarism (underactive pituitary gland)
- Growth hormone deficiency
- High triglyceride levels in the blood
- Family history of liver disease, obesity, or fatty liver
People over 50 years old, with genetic risk factors, obesity, diabetes, and symptoms of metabolic syndrome (including high triglycerides in the blood and hypertension) are more prone to develop NASH.
Complications
The primary complications that NAFLD and NASH can provoke are cirrhosis or severe liver scarring. Commonly, it begins with cirrhosis that occurs due to inflammation caused by NASH. Thus, the liver will try to reduce inflammation making certain areas of scarring (fibrosis). If you do not get treatment to stop scarring, cirrhosis can lead to the following health problems. Examples include:
- Fluid buildup that usually happens in the stomach area (ascites)
- Swollen veins in the esophagus (esophageal varices) that can rupture and bleed
- Hepatic encephalopathy (that provokes slurred speech, drowsiness, and confusion)
- Liver cancer
- Overactive spleen (hypersplenism) that provokes reduced blood platelets
- End-stage liver failure (in such cases, the liver stops working completely)
Healthcare providers think that 24% of adults in the United States have NAFLD and approximately 1.5%-6.5% have NASH.
How to Prevent Nonalcoholic Fatty Liver Disease?
Try the following tips to reduce the risk of NAFLD. For example:
- Adopt a healthy diet (which includes fruits, vegetables, whole grains, and healthy fats).
- Limit or avoid alcoholic drinks and simple sugars (including soda, sports drinks, juices, and sweet tea).
- Try to get and maintain a healthy weight (it is vital to have and keep a healthy weight because it reduces the risk not only for NAFLD but for many other health conditions). If you cannot lose weight, discuss it with your healthcare professional.
- Regular exercise (You should aim for at least 30 minutes of daily physical exercise).
Diagnosis
Sometimes, it may be challenging to diagnose this liver disease. Mostly, it is found during a regular examination because a blood test shows increased liver enzymes. Therefore, physicians may suspect you have NAFLD and perform more tests. Check below some tests done to determine damage to the liver and exclude other conditions that provoke similar symptoms:
Blood Tests
- Complete blood count
- Liver enzyme and function tests
- Iron studies
- Specific tests to check for chronic viral hepatitis (including hepatitis A, hepatitis C, and others)
- Celiac disease screening test
- Fasting blood sugar
- Hemoglobin A1C
- Lipid profile (helps to determine blood fats including triglycerides and cholesterol)
Imaging Tests
- Abdominal ultrasound – This is a primary test done if doctors suspect you have a liver disease.
- MRI (magnetic resonance imaging) or CT (computerized tomography) scans – These tests are used to produce detailed images of the liver and nearby tissues. Physicians perform MRI and CT scans to determine the NASH or NAFLD the patient has.
- Transient elastography – This is a new test that helps to measure liver stiffness which is a symptom of fibrosis or scarring.
- Magnetic resonance elastography – This test is a combination of MRI imaging and sound waves to make a visual map (elastogram).
Liver Biopsy
This test is usually done when other tests show a more advanced form of liver disease or tests are unclear. During this procedure, doctors will remove a small sample of the liver and send it to the laboratory. Moreover, this is one of the most effective ways to diagnose NASH. However, liver biopsy involves certain risks and not every time it is possible to perform it. Consult with your doctor for more details.
Treatment
Commonly, treatment for people with NAFLD begins with weight loss using a healthy diet, limiting the amount of food, and regular exercise. Sometimes, physicians may recommend a weight-loss surgery. In addition, there is a new medicine available for people with NASH. It is often prescribed by doctors for people with moderate and severe liver scarring. It is called Resmetirom and it helps to decrease fat deposits in the liver. However, if you have cirrhosis, this medicine cannot be used and the only to treat it is an organ transplant.
Frequently Asked Questions
What is the life expectancy for people with NAFLD?
In people with NASH cirrhosis diagnosed early, the life expectancy is about 10-15 years. In any case, the life expectancy decreases significantly if these people experience complications including swelling or fluid in the abdomen, confusion, or bleeding from the gastrointestinal tract.
Is it possible to reverse fatty liver?
If you have too much fat that builds up in the liver, over time it may lead to damage to the liver. However, approximately all people can reverse liver damage with a healthy diet, lifestyle changes, and limiting or avoiding alcoholic beverages. Talk with your healthcare professional for more details.
What foods can help to remove fat from the liver?
- Leafy greens (such as spinach)
- Walnuts
- High-fiber foods (such as oats)
- Salmon, sardines, tuna, trout, and other omega-3 fatty acids fish
- Turmeric and curcumin
- Sunflower seeds and other vitamin E sources
- Garlic
Ask your healthcare provider if you have additional questions.
