NAFLD has 4 stages, from simple fatty liver to cirrhosis:
- Simple fatty liver (steatosis) – Fat starts to build up in the liver.
- NASH (non-alcohol related steatohepatitis) – Fat builds up and causes inflammation which can cause damage to the liver.
- Fibrosis – Damage progresses and forms lasting scars on the liver called fibrosis.
- Cirrhosis – This increases the risk of developing life-threatening liver failure and liver cancer.
A healthy liver should have little or no fat. For most people, having a small amount of fat in their liver won’t cause a big problem. But if too much fat builds up in your liver it can cause inflammation and damage. It is estimated that one in three people in the UK are in the early stages of NAFLD. Many of those people may not even have been diagnosed with NAFLD. And most of them will never develop serious problems with their liver. Healthy living can make a big difference by stopping NAFLD from getting worse and in many cases reversing the damage.
If left alone NAFLD can get worse. Stage 4 of NAFLD is called cirrhosis, which can lead to life-threatening liver conditions including liver cancer and liver failure. About 1 in 5 people (20%) with NAFLD go on to develop NASH. And 1 in 5 of those people who have NASH will go on to develop cirrhosis. So it is very important to speak to your doctor if you think you may be at any stage of NAFLD or have any concerns about your liver health.
What causes NAFLD?
NAFLD is due to fat building up in the liver. People are more likely to develop NAFLD if they have:
- An unhealthy diet
- A weight in the overweight or obese range
- High blood lipids
- Type 2 diabetes
- An underactive thyroid
- Insulin resistance for example Polycystic Ovary Syndrome
Although most cases of NAFLD are linked to excess weight, you can develop the disease if you are a healthy weight.
In a small number of people NAFLD can be caused by other things including rare genetic conditions, prolonged fasting, rapid weight loss due to malnutrition, starvation, or surgery for obesity (bariatric surgery), some drug treatments, or intravenous feeding (parenteral nutrition).
Are you concerned that you might be at risk?
What are the symptoms of NAFLD?
NAFLD often causes no symptoms. This is especially true in the early stages. If you have early stage NAFLD you may experience:
- discomfort in the upper right part of your abdomen, where your liver is
NASH, fibrosis and cirrhosis may not show symptoms for many years.
People with a liver condition who develop any of the following symptoms should seek urgent medical attention:
- yellowness of the eyes and skin (jaundice)
- bruising easily
- dark urine
- swelling of the lower tummy area (ascites)
- vomiting blood (haematemesis)
- dark black tarry faeces (melena)
- periods of confusion or poor memory (encephalopathy)
- itching skin (pruritus)
Read more about the symptoms of liver disease here.
You might only find out you have a fatty liver when it is diagnosed during tests for another health problem. If this happens you may be asked a lot of questions about your lifestyle, such as any drugs you are taking (including over-the-counter medication and nutritional supplements), your diet, the amount of exercise you do and the amount of alcohol you drink.
It is important to give your doctor as much information as you can. This will help them to diagnose your condition correctly and give you the right care.
Tests that you might have include:
- Liver blood tests
- CT or CAT scan
- MRI scan
- Liver biopsy
There is no specific medical treatment for NAFLD that all doctors agree on.
If your NAFLD is linked to weight or diet your doctor is likely to treat it by giving you advice on living more healthily. This includes eating a well-balanced diet, being more physically active and losing weight (if needed). This might seem like very general advice but there is good evidence that gradual weight loss, eating healthily and being more physically active can reduce the amount of fat in your liver. This can help your liver to undo any damage.
In early stage NAFLD your doctor may also concentrate on treating or managing any other conditions you have such as diabetes, high blood pressure or high cholesterol. These conditions are linked to fatty liver disease.
If you have early stage NAFLD or NASH you should have regular monitoring to check that it is not progressing. This is important because there are often no symptoms to tell you that your liver is getting more damaged. You should have testing for advanced fibrosis every 3 years or every 2 years for children and young people.
If your NAFLD progresses to cirrhosis or advanced liver disease your doctor will consider what other treatment you need. This could include a liver transplant or medicines to help manage side effects. And they will offer you scans to check for liver cancer every 6 months. This is called surveillance. You can read more about cirrhosis here.
NAFLD can be reversed by removing the root cause and giving the liver a chance to repair itself. For most people with NAFLD this means losing weight through healthy eating and physical activity.
The less damage your liver has, the easier it is likely to be to reverse. But even if there is significant damage the liver can repair itself to some degree.
If you are overweight, losing 5 to 10% of your bodyweight has been shown to control and in some cases reverse NAFLD. If you weigh 14 stone (89kg) that means losing around 10 to 20 pounds (5 to 10kg) in total.
Aim to lose weight steadily. Losing 0.5 to 2 pounds (0.25 to 1kg) a week is a safe and realistic goal.
Losing weight can also reduce blood pressure, reduce cholesterol and improve diabetes control along with many other health benefits.
The best ways to lose weight are to eat a well balanced diet and become more physically active. This helps to change the energy balance in your body so that you use more energy (calories) than you take in. Excess energy is stored as fat, so your body will start to use its fat stores to make up the difference. Read more about keeping a healthy weight here.
Your doctor can give you advice on losing weight and can often refer you to a weight loss programme or dietitian to help you lose weight. If you have a BMI of 35 or more and are struggling to lose weight you should ask to be seen by specialist weight management services. They have access to more specialist teams and will consider a range of treatments that may include medicines or surgery.
Our Treating NAFLD with a healthy diet and physical activity booklet has detailed information and tips to help you eat more healthily, get more active and lose weight. Download it here.
Even if you don’t need to lose weight eating healthily helps stop you putting on weight which could damage your liver more. It’s also a good way to protect and improve your general health. Find out what a well balanced diet means here.
For most people it is healthier to lose weight steadily over time.
There is some evidence that very low calorie diets can be used to treat or manage metabolic disease (including NAFLD). Talk to your doctor before starting to follow a diet with very low calorie intake or that cuts out certain types of food altogether.