Non-Alcohol Related Fatty Liver Disease

NAFLD is the name given to a condition in which you have too much fat in your liver. 

There should be little or no fat in a healthy liver and for most people, carrying a small amount of fat in the liver causes no major problems.

Too much fat in your liver is caused by the build-up of fats called triglycerides.

Triglycerides the most common fats in our bodies, they belong to a group of fatty, waxy substances called lipids, which your body needs for energy and growth. We get triglycerides from our diet. Foods high in fat and sugar contain high amounts of triglycerides. They can also be made in the liver from sugars and proteins.

NAFLD is characterised by the build-up of excess fat in the liver of people who do not drink more than recommended guideline amounts of alcohol.
The first stage is fatty liver, or steatosis. This is where fat accumulates in the liver cells without any inflammation or scarring. For many people, the condition will not advance and a serious liver confition will no develop, but for some, NAFLD can progress on to NASH.

NASH is a more significant condition, as it may cause scarring to the liver, and can progress to cirrhosis. Cirrhosis causes irreversible damage to the liver and is the most severe stage of NAFLD.

It may be easiest to think of NAFLD as having the following stages:
1.  Non-alcohol related fatty liver or steatosis
2.  Non-alcohol related steatohepatitis (NASH)
3.  NASH with fibrosis
4.  Cirrhosis.

NAFLD can affect a wide range of people. In general, the more overweight you are, the more chance there is that you may have the condition. NAFLD is typically seen in people aged around 50 and more commonly in men than women.


It is hard to be precise about how many people have some for of NAFLD but it is estimated that one in five people (20%) in the UK are in the early stages of the condition will not develop, but for some, NAFLD can.


It is hard to be precise about how many people have NAFLD but it is estimated that one in five people (20%) in the UK are in the early stages of the condition.  

Pioneering Liver Health
NASH is a more aggressive form of NAFLD where there is inflammation in and around the fatty liver cells. This may cause swelling of your liver and discomfort around it. If you place your right hand over the lower right side of your ribs, it will cover the area of your liver.


Over a long period of time, ongoing inflammation leads to a build-up of scar tissue in your liver. This process is known as fibrosis and can lead to cirrhosis.


NASH is now considered to be one of the main causes of cirrhosis; many cases of cryptogenic (of unknown origin) cirrhosis are now being recognised as being caused by NASH.


Cirrhosis is usually the result of long-term, continuous damage to the liver. This is where irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes harder. The effect of this, together with continued scarring from fibrosis, means that the liver will run out of healthy cells to support normal functions.


This can lead to complete liver failure. 

What are the symptoms?

How is IT diagnosed?

Most people with mild NAFLD are unlikely to notice any symptoms. Some may experience discomfort n the liver area and tiredness.

For those who go on to develop NASH, Fibrosis and Cirrhosis it may be many years before symptoms develop. The following symptoms may indicate a serious development in your liver condition. Patients with a liver condition who develop any of the following symptoms should see 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)

In most cases people only find out they have a fatty liver when a routine blood sample (usually liver function tests) shows there may be a 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.

Further tests may be needed to confirm the diagnosis such as an Ultrasound, FibroScan, CT or CAT Scan or MRI scan. In some cases a liver biopsy may be needed.

Treatment

There is no specific treatment for NAFLD that all doctors agree on.

However, if your NAFLD is linked to being overweight then you will be advised to make various lifestyle changes including losing weight gradually and taking sensible exercise. There is good evidence that gradual weight loss coupled with increased exercise can reduce the amount of fat in your liver.

In mild cases of NAFLD doctors may concentrate on treating associated conditions, such as obesity and diabetes, which can cause fat to build up. They will also treat disorders such as high blood pressure and high cholesterol as these are often associated with NAFLD. 

For full information download the publication below.

 

 

Download publication

Download: Non-Alcohol Related Fatty Liver Disease FLD/03/18.pdf

 View references here

Reviewed by: Professor Mark Thursz, Professor of Hepatology, Hepatology Section, Division of Medicine, Imperial College, London; Professor Chris Day MA PhD MD FRCP FMedSci Professor of Liver Medicine, Institute of Cellular Medicine, University of Newcastle-upon-Tyne; Dr Phil Newsome PhD FRCPE Senior Lecturer in Hepatology & Consultant Hepatologist, Centre for Liver Research, University of Birmingham.

Further Information

Maintaining a healthy weight through eating a well-balanced diet and taking regular exercise is the best way to prevent NAFLD. The health risks from being overweight or obese can impact on your physical, social and emotional well being. People with NAFLD who go on to develop Cirrhosis are at a higher risk of liver failure.

Although it is not always possible to avoid NAFLD, as some factors such as genetics cannot be prevented, you can significantly reduce your risk by exercising as much as you are able to, and eating healthily to control your weight (see our diet and liver disease information).

Better control of existing medical conditions, such as glucose levels in diabetes, can also help prevent the development of NAFLD and NASH.

NICE have published a new quality standard Obesity in adults: prevention and lifestyle weight management programmes. Click here to view.

NICE have also issued a new guideline on how to identify the adults, young people and children with non-alcohol related fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications. It outlines the lifestyle changes and treatments that can manage NAFLD and advanced liver fibrosis.

Click here to view the guidance.
Click here to view the information for the public.

Please visit the support section of our website for information on Support groups in your area or visit our Useful Links section for other organisations who may be able to offer information and support.