Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a term for a range of liver conditions. As the name implies, the main characteristic of NAFLD is too much fat stored in liver cells.

Some individuals with NAFLD can develop nonalcoholic steatohepatitis (NASH) — an aggressive form of fatty liver disease, which is marked by liver inflammation and may progress to advanced scarring (cirrhosis) and liver failure. This damage is similar to the damage caused by heavy alcohol use.

NAFLD usually causes no signs and symptoms unless cirrhosis is present, including:

• Abdominal swelling
• Lower extremity swelling (edema)
• Impaired mental abilities (memory, attention, concentration)
• Yellowing of the skin and eyes (jaundice)
• Dark urine
• Itching (pruritus)

Causes

Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis.

NAFLD and NASH are linked to:

• Obesity or being overweight
• Insulin resistance, in which cells don't take up sugar in response to the hormone insulin
• High blood sugar (hyperglycemia), indicating prediabetes or Type 2 diabetes
• High levels of fats, particularly triglycerides, in the blood

These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and NASH, which may lead to a buildup of scar tissue in the liver.

It is difficult to distinguish NAFLD from NASH without further testing.

Treatment

The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. You can:

• Lose weight.
  If you're overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight. Calorie reduction is the key to losing weight and managing this disease. If you have tried to lose weight in the past and have been unsuccessful, ask your doctor for help.
• Choose a healthy diet.
  Eat a healthy diet that's rich in fruits, vegetables and whole grains.
• Exercise and be more active.
  Aim for at least 30 minutes of exercise most days of the week. If you're trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
• Control your diabetes.
  Follow your doctor's instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar.
• Lower your cholesterol.
  A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.
• Protect your liver.
  Avoid things that will put extra stress on your liver. For instance, don't drink alcohol. Follow the instructions on all medications and over-the-counter drugs. Check with your doctor before using any herbal remedies, as not all herbal products are safe.