Nonalcoholic Fatty Liver Disease
What is nonalcoholic fatty liver disease?
Fatty liver disease means that you have extra fat inside your liver. This extra fat
keeps your liver from doing a good job of removing toxins from your blood. People
who drink too much alcohol may have fat in their liver. When the fatty liver does
not come from drinking too much alcohol, it is called nonalcoholic fatty liver disease.
There are 2 types:
Nonalcoholic fatty liver disease (NAFLD). This type is when you have fat in your liver. But your liver is not damaged. It is
also called metabolic dysfunction-associated fatty liver disease.
Nonalcoholic steatohepatitis (NASH). This type is when you have fat in your liver. You also have signs of inflammation
and liver cell damage.
What causes nonalcoholic fatty liver disease?
Healthcare providers don’t know the exact cause of nonalcoholic fatty liver disease.
Certain health conditions are closely linked to NAFLD. These include obesity, insulin
resistance, metabolic syndrome, type 2 diabetes, high cholesterol, and high triglycerides.
These conditions may lead to extra fat in the liver or fatty liver disease.
Who is at risk for nonalcoholic fatty liver disease?
Children and young adults can get this disease. But it is most common in middle age.
Risk factors include:
Being overweight or obese, especially having too much belly fat (central obesity)
Having high blood fat levels (either triglycerides or LDL cholesterol)
Having type 2 diabetes or prediabetes
Having high blood pressure
When these risk factors happen together, they cause a health problem called metabolic
syndrome. People with metabolic syndrome often have fatty liver. They also are more
likely to have heart disease. Other conditions that may raise your risk include polycystic
ovary syndrome, sleep apnea, and hypothyroidism.
What are the symptoms of nonalcoholic fatty liver disease?
Nonalcoholic fatty liver disease is sometimes called a silent liver disease. This
is because it can happen without causing any symptoms. Most people with NAFLD live
with fat in their liver without getting liver damage. A few people who have fat in
their liver develop nonalcoholic steatohepatitis (NASH).
If you have NASH, you may have symptoms. But it could take years for them to show
up. Sometimes liver damage from NASH causes long-term scarring and hardening of your
liver. This is called cirrhosis. It also increases risk for liver cancer. Symptoms
from NASH may include:
Severe tiredness (fatigue)
Pain in the right upper belly (abdomen)
Yellowing of the skin or eyes (jaundice)
Spiderlike blood vessels on the skin
NASH that turns into cirrhosis could cause these symptoms:
These symptoms may look like other health problems. Always see your healthcare provider
for a diagnosis.
How is nonalcoholic fatty liver disease diagnosed?
Nonalcoholic fatty liver disease can happen without causing any symptoms. It’s often
diagnosed when you have routine blood tests to check your liver. Your healthcare provider
may think you have it if your test results are abnormal. This is especially true if
you are obese or have diabetes.
Your healthcare provider may use these tests to help make a diagnosis:
Imaging tests. Ultrasound, CT scan, or MRI may show fat deposits in your liver.
Blood test. A special blood test can check how diseased your liver is.
Liver biopsy. The provider puts a long needle through your skin into your liver. The needle removes
a small piece of liver tissue. The tissue can be looked at under a microscope.
Based on the test results, your healthcare provider will make the following diagnosis:
You have NAFLD if you have fat but no inflammation or tissue damage.
You have NASH if you have fat, inflammation, and liver damage.
You may be developing cirrhosis if you have a type of scar tissue in your liver called
How is nonalcoholic fatty liver disease treated?
If you have NAFLD without any other health problems, you don’t need any special treatment.
But making some lifestyle changes can control or reverse the fat buildup in your liver.
These may include:
If you have NASH, no medicine can fully reverse the fat buildup in your liver. Sometimes
the liver damage stops or even reverses itself. But for other people, the disease
keeps getting worse. If you have NASH, it’s important to control any conditions that
may help cause the disease. Treatments and lifestyle changes may include:
Taking medicine to lower cholesterol or triglycerides
Taking medicine to lower blood pressure
Taking medicine to control diabetes
Limiting over-the-counter medicines
Not drinking alcohol. No amount of alcohol is known to be fully safe once you have
Eating a diet low in fat and simple carbohydrates
Seeing a liver specialist
Your healthcare provider may advise certain medicines if you have NASH. These include
vitamin E in people without diabetes or heart disease. And they include pioglitazone,
a diabetes medicine for people with or without diabetes. But these have side effects,
so talk about them with your healthcare provider. Other medicines, including certain
herbal supplements, are being looked into. Treating the underlying conditions is the
absolute most important thing, and is more effective than any medicine.
What are possible complications of nonalcoholic fatty liver disease?
The main complication is that NASH can become cirrhosis. Cirrhosis means lasting (permanent)
scarring and hardening of the liver. People with cirrhosis may develop liver failure
and need a liver transplant. NASH may also progress to liver cancer. Talk with your
healthcare provider about any concerns you may have.
How do I manage nonalcoholic fatty liver disease?
If you have nonalcoholic fatty liver disease, learn as much as you can about your
condition. Work closely with your healthcare team. Many medicines can harm your liver.
So always tell all your healthcare providers about any medicines you are taking. These
include over-the-counter medicines, dietary supplements, herbs, and vitamins.
Other ways to manage the disease include:
Be sure to ask your healthcare provider about recommended vaccines. These include
vaccines for viruses that can cause liver disease.
When should I call my healthcare provider?
Call your healthcare provider if you have any symptoms that mean nonalcoholic fatty
liver disease is getting worse. These are:
Key points about nonalcoholic fatty liver disease
Fatty liver disease means that you have extra fat inside your liver. When this is
not caused by drinking too much alcohol, it is called nonalcoholic fatty liver disease
or metabolic dysfunction-associated liver disease.
Obesity may be the most common cause of this disease.
Nonalcoholic fatty liver disease can happen without causing any symptoms.
Blood tests and imaging tests, such as a CT scan and ultrasound, can help diagnose
Losing weight and making other lifestyle changes can help control and even reverse
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis and any new medicines, treatments,
or tests. Also write down any new directions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your healthcare provider if you have questions, especially
after office hours and on weekends and holidays.