Fatty Liver Disease: Are You At Risk?

As the name suggests, nonalcoholic fatty liver disease (NAFLD) is a term that describes a range of liver conditions among people who drink little to no alcohol. While the causes may differ, those who have NAFLD share one thing: too much fat stored in their liver cells.

Having small amounts of fat in the liver is normal. Having too much fat can cause the liver to become inflamed, which, over time, may cause scarring and may even lead to liver cancer or liver failure.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NAFLD is one of the most common causes of liver disease  -- affecting about 24% of adults in the United States. But NAFLD can affect people of any age, including children. Research suggests that close to 10% of U.S. children ages 2 to 19 have NAFLD. However, people are more likely to develop NAFLD as they age.

Types of Nonalcoholic Fatty Liver Disease

• Nonalcoholic fatty liver (NAFLD) refers to having excess fat in the liver, but no inflammation or liver cell damage. In patients with NAFLD, the liver functions normally and there are no symptoms. It is now the most common cause of liver disorder in the U.S.
• Nonalcoholic steatohepatitis (NASH) is a form of NAFLD characterized by inflammation of the liver (hepatitis) resulting in liver cell damage, in addition to excess fat in the liver. NASH can lead to fibrosis (scarring) of the liver and possibly cirrhosis, liver failure, or liver cancer. Some people with NASH may need a liver transplant to survive.

It is currently unknown why some people with nonalcoholic fatty liver disease have NASH while others do not.

Causes

The liver is the largest organ in the body and serves many vital functions, including aiding in the removal of toxins and waste products from the body. Although the cause of NASH is unknown, it is most frequently seen in people with one or more of following conditions:

• Obesity (70% of people with NASH are obese)
• Type 2 diabetes (up to 75% of people with NASH have diabetes)
• High blood pressure
• Insulin resistance
• High levels of fats in the blood (i.e. cholesterol, triglycerides)
• Drug and toxin exposure (some medications and toxins have been associated with NAFLD, including steroids, synthetic estrogens, and certain chemotherapy medications)

Symptoms and Diagnosis

Usually a "silent disease," NAFLD causes few or no symptoms.

Possible signs include:

• Fatigue
• Weakness
• Weight loss or loss of appetite
• Nausea
• Abdominal pain
• Jaundice

Dr. Hannah Do, gastroenterologist at Doylestown Health Gatroenterology, states that “elevated liver enzymes on routine blood tests along with certain metabolic risk factors can suggest NAFLD. A diagnosis can be determined on imaging tests such as ultrasound, fibroscan, CT scan, or MRI scan. If that is not clear, a liver biopsy can even be pursued for confirmation.”

Treatment

Nonalcoholic fatty liver disease requires care by a specialist who is specially trained in a wide range of liver diseases and disorders. Hepatology, a subspecialty of gastroenterology, is a branch of medicine that focuses on the diagnosis, treatment, and management of any disturbance of proper liver function.

Treatment options that a gastroenterologist or hepatologist may recommend include:

• Adopting a healthy diet, limiting caloric intake and adding fruits, vegetables, and whole grains
• Gradual weight loss monitored by a registered dietitian/medical weight loss professional
• Risk factor control: tight glucose control (diabetes), lowering cholesterol and triglycerides
• Regular exercise
• Reviewing all medications with the doctor, stopping certain medications or switching to other medicines as needed
• Getting vaccinations for hepatitis A and B, the flu, and pneumococcal disease
• Avoiding alcohol intake
• Liver transplant