NAFLD, or non-alcoholic fatty liver disease, is a rising global health issue that affects around 25% of people worldwide. This group of liver diseases is distinguished by the buildup of hepatic fat without a substantial alcohol intake. NAFLD includes non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis, fibrosis, liver failure, and potentially hepatocellular carcinoma (HCC).
NAFLD is frequently associated with insulin resistance, dyslipidemia, type 2 diabetes mellitus, obesity, and metabolic syndrome. For prevention and management, early identification and lifestyle modification are essential because the illness is mainly asymptomatic in its early stages.
To effectively manage and prevent NAFLD, we will examine its causes, symptoms, diagnostic tools, treatment options, self-care techniques, and lifestyle changes.
What is the Definitions of NAF, NAFLD, and NASH
1. NAF (Non-Alcoholic Fatty Liver)
The term “non-alcoholic fatty liver” (NAF) describes steatosis, or excess liver fat, that occurs without substantial alcohol intake.
In terms of the NAFLD spectrum, it represents the initial stage of liver involvement. Simple steatosis, or liver fat buildup without inflammation or damage to liver cells, is a hallmark of nonalcoholic steatosis.
Key features include:
• Fat makes up at least 5% of hepatocytes;
• There is no noticeable fibrosis or inflammation;
• It is typically asymptomatic and curable with lifestyle modifications;
• It can lead increase in severity over time.
2. NAFLD (Non-Alcoholic Fatty Liver Disease)
An umbrella term for liver diseases brought on by fat buildup in the liver in people who drink little to no alcohol is Non-Alcoholic Fatty Liver Disease (NAFLD).
Simple fatty liver (NAF) and non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis, fibrosis, and liver failure, are among the liver diseases that are included in nonalcoholic steatohepatitis (NAFLD).
Key features include:
- The liver’s buildup of fat (≥5% hepatocytes).
• Occurs in people who consume little to no alcohol (less than 30 grams per day for men and less than 20 grams per day for women)
.• Closely linked to metabolic syndrome, type 2 diabetes, obesity, and insulin resistance.
Both benign (NAF) and progressive (NASH and fibrosis) forms of NAFLD are possible.
3. NASH (Non-Alcoholic Steatohepatitis)
The more severe and progressive form of non-alcoholic steatohepatitis (NASH) is characterized by hepatocyte damage (ballooning), inflammation, and different degrees of fibrosis, along with fat accumulation in the liver.
Hepatocellular carcinoma (HCC), cirrhosis, severe fibrosis, and liver failure can result from untreated NASH
Key features include:
• A buildup of fat accompanied by inflammation of the liver and cell damage (ballooning degeneration).
• Liver failure, cirrhosis, and fibrosis could develop
• More likely to happen in those with metabolic syndrome, obesity, diabetes, or genetic predispositions;
• NASH has a higher risk of liver-related consequences than basic NAFLD.
Causes of NAFLD
Although the precise etiology of NAFLD is unknown, a number of variables have a role in its development:
1. One major factor contributing to the liver’s increased fat storage is insulin resistance.
2. Obesity: One of the main risk factors is excess body fat, especially visceral fat.
3. Type 2 Diabetes: The buildup of liver fat is made worse by inadequate blood sugar regulation.
4. Metabolic Syndrome: Contains elevated triglycerides, cholesterol, and blood pressure.
5. Genetics: A family’s history may make a person more susceptible.
6.Dawful Diet: Consumes a lot of sugar, saturated fats, and processed foods.
7. Sedentary Lifestyle: Metabolic dysfunction and weight gain are caused by a lack of physical activity.
Symptoms
NAFLD is often asymptomatic, but some people experience fatigue, right upper abdominal discomfort, and unexplained weight loss. Advanced disease may cause jaundice, swelling, confusion, and easy bruising.
Typical Signs of NAFLD
1. Weakness and Fatigue
An early indication of metabolic inefficiency and liver inflammation is unexplained fatigue. Fatigue from NAFLD is frequently chronic and does not go away with rest.
2. Upper Abdominal Pain on the Right
a dull ache or discomfort in the abdomen’s upper right quadrant, which houses the liver. Hepatomegaly, or liver enlargement brought on by fat buildup, could be the cause of this.
3. Inexplicable Loss of Weight
observed in patients with growing liver damage and in more advanced stages of nonalcoholic fatty liver disease.
4. Mild jaundice, which is uncommon in early NAFLD
Usually seen in advanced stages of the disease, yellowing of the skin and eyes is caused by reduced liver function.
5. Hepatomegaly (enlarged liver): This condition is frequently found when a clinician palpates the abdomen during a physical examination.
Symptoms of Advanced NAFLD (NASH, Cirrhosis, or Liver Failure)
More serious symptoms could appear if NAFLD develops into non-alcoholic steatohepatitis (NASH), fibrosis, or cirrhosis such as:
1. Jaundice, which is a yellowing of the skin and eyes brought on by liver disease.
2. Edema and Ascites (abdominal fluid accumulation and leg swelling).
3. A buildup of toxins in the brain that causes mental confusion (hepatic encephalopathy).
4. Bruising and bleeding from liver impairment are easy.
5. Skin blood vessels that resemble spiders, or spider angiomas.
6. Palmar Erythema, which is characterized by redness in the palms brought on by liver disease.
NAFLD is frequently silent, thus screening and routine checkups are essential for early detection in those who are at risk.
Diagnosis
NAFLD is typically diagnosed incidentally during routine medical tests when liver function tests show abnormalities or imaging studies detect fat in the liver. The diagnosis involves clinical evaluation, blood tests, imaging studies, and sometimes a liver biopsy.
Blood tests: Assess liver enzymes, glucose, cholesterol, and fibrosis risk scores.
Imaging studies: Ultrasound, FibroScan, MRI-PDFF, and CT scans help detect fatty liver and fibrosis.
Non-invasive scoring systems: NAFLD Fibrosis Score (NFS), FIB-4 Index, and APRI Score help assess fibrosis risk.
Liver biopsy: Performed in select cases to confirm NASH and evaluate disease severity.
Early diagnosis is critical because NAFLD can progress silently to severe liver disease. People at high risk (obesity, diabetes, metabolic syndrome) should undergo regular screening for NAFLD to prevent complications.
What is Fibroscan and how to interpret it?
Fibroscan
FibroScan, also called “Transient Elastography”, is an specialised ultrasound procedure that evaluates liver stiffness and fat accumulation using shear wave technology.
People with the following conditions are advised to get a Fibroscan:
- Suspected NAFLD or NASH
- Elevated liver enzymes (ALT, AST)
- Chronic hepatitis B or C
- Obesity or type 2 diabetes
- History of alcohol abuse
- Tracking the course of liver disease or recovery after treatment
How to Interpret FibroScan Findings
1. Liver Stiffness (Fibrosis Stages):
– F0-F1: No or mild fibrosis (normal to early stage).
– F2: Moderate fibrosis.
– F3: Severe fibrosis.
– F4: Cirrhosis (advanced scarring).
2. CAP Score (Fat Content): The Controlled Attenuation Parameter is often used with FibroScan to assess liver fat.
– <238 dB/m: No steatosis.
– 238-260 dB/m: Mild steatosis.
– 260-290 dB/m: Moderate steatosis.
– >290 dB/m: Severe steatosis.
3. Liver stiffness
- less than 7 kPa is normal
- more than 7 kPa suggests significant fibrosis
- more than 14 kPa suggests cirrhosis
What are the Lifestyle Changes recommended for NAFLD?
- Weight Reduction:
For overweight/obesity NAFLD, aim for a sustainable, healthful diet that reduces weight by 5–10%.
Even when a person’s BMI is within a normal level, losing 3–5% of body weight can be advantageous, particularly if they have recently gained weight or are obese in the abdomen.
2. Suggested Foods
✅ Good options include:
• Olive oil
• Polyphenols
• Omega-3 fatty acids (found in walnuts and salmon)
• Fruits, vegetables & Meals prepared at home
• Mediterranean food habits
3. Foods Not Suggested / Less Consumption
🚫 Limit or stay away from:
• Added sugars (cut back on processed meals, sweets, and sugary dairy and drinks);
• Saturated fat and cholesterol (choose low-fat dairy and meat).
• Highly processed meals and beverages
• Processed and red meats
4. Suggested Exercise
🏃 Exercise Suggestions:
• Aerobic exercise: ≥ three days per week (≥ 150 minutes per week of moderate vigor)
• Lessen sedentary behaviour by engaging in resistance training at least twice a week.
- Avoid Alcohol: To stop additional liver damage, completely refrain from drinking alcohol.
- Watch Your Drugs: Before starting any new medicine, speak with your doctor because some drugs can damage your liver.
5. Avoid Alcohol: To stop additional liver damage, completely refrain from drinking alcohol.
6. Watch Your Drugs: Before starting any new medicine, speak with your doctor because some drugs can damage your liver.
What are the NAFLD Treatment Options Available?
- Although there isn’t a single authorised drug for NAFLD, treatment aims to target the underlying reasons and stop the disease’s progression. Changes in lifestyle is the foundation of managing non-alcoholic fatty liver disease.
- Medications: Patients with NASH who are not diabetics may be prescribed vitamin E, an antioxidant.
- Pioglitazone can help with liver health (for diabetes).
- GLP-1 receptor agonists, like semaglutide, have the potential to lower liver fat.
- Bariatric Surgery: Surgery to reduce body weight can help those with severe obesity with their NAFLD.
- In cases of extensive cirrhosis or liver failure, a liver transplant may be required.
Final Thoughts
NAFLD is one of the most prevalent liver conditions in the world, and serious liver damage can be avoided with early identification.
Even though a large number of NAFLD patients may not exhibit any symptoms, routine examinations and imaging procedures such as FibroScan can be used to evaluate liver health.
Weight loss, dietary adjustments, and increased physical activity are examples of lifestyle changes that can greatly enhance liver function and stop the progression of the disease if detected early.
People with NAFLD can take charge of their liver health and lower their chance of cirrhosis or liver failure in the future by being proactive
Thanks a lot for sharing the article.
Welcome Sonali 🙂