Nonalcoholic Fatty Liver Disease: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Nonalcoholic fatty liver disease, or NAFLD for short, is a liver disease that can affect people who drink little or no alcohol. In NAFLD, the liver collects an excessive amount of fat. The people who experience it most commonly are those who are obese or overweight.

NAFLD is becoming more commonplace worldwide as the number of obese individuals rises, especially in Western and Middle Eastern nations. It affects about 25% of people globally and is the most common type of chronic liver disease. 

A disorder known as nonalcoholic steatohepatitis, or NASH, can affect some NAFLD patients. NASH is a severe form of fatty liver disease that causes damage and swelling to the liver due to fat accumulation in the liver. NASH can lead to cirrhosis, a severe form of liver damage, and potentially even liver cancer as it progresses. This harm is comparable to the harm caused by binge drinking.

There is currently a push to replace the term "nonalcoholic fatty liver disease" with "metabolic dysfunction-associated steatotic liver disease" (MASLD). Experts also recommend changing the term "nonalcoholic steatohepatitis" to metabolic dysfunction-associated steatohepatitis (MASH).

Causes Of Nonalcoholic Fatty Liver Disease

Experts are uncertain of the precise cause of why fat builds up in certain livers but not in others. Furthermore, the exact cause of NASH development in certain fatty liver remains unknown.

NAFLD and NASH are related to the following:

• Heredity
• Either overweight or obese.
• Your cells don't take up sugar in response to the hormone insulin, which leads to insulin resistance.
• Hyperglycemia or increased blood sugar, type 2 diabetes.
• High levels of blood fat, especially triglycerides.

An accumulation of these illnesses may result in a fatty liver. However, some people can acquire NAFLD in the absence of any risk factors.

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Symptoms Of Nonalcoholic Fatty Liver Disease

 NAFLD frequently has no symptoms. When it does, these can include:

• Fatigued.
• Malaise, or a feeling ill.
• Abdominal pain or discomfort in the upper right area.

Potential indicators of NASH and cirrhosis, or severe scarring, include the following:

• Inflammation of the skin.
• Abdominal swelling is also known as ascites
• Breathing difficulty.
• The swelling in the legs.
• Tiny blood vessels that resemble spiders through the skin.
• Enlarged spleen.
• Red palms.
• Jaundice.

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Risk Factors Of Nonalcoholic Fatty Liver Disease

Several diseases and disorders can increase your risk of developing non-alcoholic fatty liver disease (NAFLD), including:

• A family history of obesity or fatty liver diseases
• A growth hormone deficiency is brought on by the body producing insufficient amounts of these hormones.
• Raised cholesterol levels.
• Higher than normal blood triglyceride levels.
• Insulin resistance.
• The metabolic syndrome.
• Excess weight, especially if it is mostly concentrated around the waist.
• Polycystic ovarian syndrome symptoms.
• Obstructive sleep apnea.
• Diabetic condition type 2.
• An underactive thyroid is sometimes called hypothyroidism.
• Low pituitary gland activity is known as hypopituitarism.

NASH is more likely to occur in these categories:

• Individuals above 50.
• Individuals who meet specific genetic risk criteria.
• Those who are overweight.
• Individuals with diabetes or elevated blood sugar levels.
• People with elevated blood pressure

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Diagnosis Of Nonalcoholic Fatty Liver Disease

NAFLD is often diagnosed by tests that show a liver problem but were done for other reasons because the disease typically has no symptoms. For instance, increased liver enzyme levels found during a yearly physical examination may lead to the diagnosis of nonalcoholic fatty liver disease (NAFLD) and further testing.

NAFLD is diagnosed, other conditions are ruled out, and the extent of liver damage is evaluated using the following tests:

• Total blood count (TBC) tests.
• Studies on iron, display the quantity of iron in your blood and other cells.
• Evaluations of the liver's enzymes and function.
• Examinations to rule out chronic viral hepatitis, including hepatitis A and C.
• Screening test for celiac disease.
• Blood sugar levels when not eating.
• The blood sugar stability indicator is hemoglobin A1C.
• A measurement of blood fats, such as cholesterol and triglycerides, is called a lipid profile.

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Imaging methods

To diagnose NAFLD, the imaging tests listed below are utilized:

• Abdominal ultrasonography is often the first test ordered when a liver ailment is suspected.
• Scanning with magnetic resonance imaging (MRI) or computerized tomography (CT). These tests are more useful in identifying mild liver fibrosis, although they cannot differentiate between NASH and NAFLD.
• Transient elastography is a more modern type of ultrasonography that measures the stiffness of your liver. 
• Magnetic resonance elastography (MRI elastography) combines sound waves and MRI imaging to create an elastogram, or visual map, that shows the rigidity of body tissues.

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Hepatocellular biopsy

If further testing reveals signs of NASH or more severe liver disease, or if the results of your tests are unclear, your doctor may suggest a liver biopsy. A small sample of liver tissue is taken for a liver biopsy. For this surgery, an abdominal wall needle is typically used. The tissue sample is analyzed in a lab for signs of inflammation and scarring. A liver biopsy is the most reliable technique to identify NASH and show the degree of liver damage.

You will have a full discussion with your medical team about the possible dangers and discomforts associated with a liver biopsy. A needle is passed through the abdominal wall and into the liver during this procedure.

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Treatment Of Nonalcoholic Fatty Liver Disease

 The first step in treating NAFLD is frequent weight loss. This can be accomplished in part by exercising, eating a balanced diet, and managing portion amounts. Losing weight could help with several health problems that lead to NAFLD. It is generally recommended to reduce your body weight by at least 10%. Nevertheless, there are benefits to losing even 3% to 5% of your starting weight. Medication or surgery for weight loss may also be helpful for some people.

A liver transplant may be required in people with NASH-related cirrhosis.

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Prevention Of Nonalcoholic Fatty Liver Disease

To reduce your risk of NAFLD:

• Eat a well-balanced diet: Eat a diet rich in whole grains, fruits, veggies, and healthy fats to stay healthy.
• Limit alcohol, simple sugars, and portion sizes: Avoid sugary liquids such as juices, soda, sweet tea, and sports drinks. Alcohol can damage your liver, therefore you should limit or stay away from it.
• Maintain a healthy weight: If you're obese or overweight, work with your healthcare team to gradually lose weight. Eat a balanced diet to stay at a healthy weight, and engage in regular exercise.

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Complications Of Nonalcoholic Fatty Liver Disease

NAFLD and NASH primarily result in cirrhosis or severe liver scarring. Cirrhosis arises from harm to the liver, such as that caused by NASH inflammation. To reduce the inflammation, the liver creates areas of scarring or fibrosis. The fibrosis grows and absorbs more liver tissue as long as the inflammation lasts.

Cirrhosis may lead to the following if the scarring is not stopped:

• Ascites.
• Varices are esophageal varices, or enlarged veins that could burst and cause bleeding.
• Confusion, fatigue, and slurred speech are also known as hepatic encephalopathy.
• Insufficient blood platelets can be caused by hypersplenism or an overworked spleen.
• Cancer of the liver.
• End-stage liver failure is a sign that the liver has stopped working.

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