Non-alcoholic Fatty Liver Disease

 

Introduction

Non-alcoholic fatty liver disease (NAFLD) describes a range of conditions due to a build up of fat within the liver. It is thought to be part of a newly termed condition called ‘metabolic syndrome’ which affects patients who are usually obese or overweight. By definition NAFLD occurs in people who do not drink excessive amounts of alcohol and have no other causes of liver disease.

How common is NAFLD?

NAFLD is the most common chronic liver disorder in the United Kingdom. It is estimated to affect up to 15-20% of the population.

Who gets NALFD?

There are a number of risk factors for developing NAFLD, these include:

  1. Overweight and Obese people
  2. Diabetes
  3. High Cholesterol
  4. High blood pressure (hypertension)
  5. Certain medications
  6. Age, NAFLD is more common in over 50’s


What is NAFLD?

NAFLD is comprised of a range of liver conditions which can be divided in to the following stages:

Fatty liver: Excess fat is stored in the liver cells. This normally does not cause symptoms and does not cause any harm or problems to the liver. However, this condition can progress to other stages of NAFLD. Blood tests may be normal but can also show abnormal Liver function tests (LFTs).

Non-alcoholic steatohepatitis (NASH): in this condition the excess fat in the liver may cause inflammation. This condition may cause problems in the long term due to the inflammation causing fibrosis/ scarring in the liver. LFTs are often abnormal in this stage.

Fibrosis: The long term effects of NASH can lead to scarring of the liver, called fibrosis. This may progress to the final stage of liver disease over a long time.

Cirrhosis: Cirrhosis is a serious condition where normal liver tissue is replaced by a lot of fibrosis. The structure and function of the liver are badly disrupted.

What are the symptoms of NALFD?

Most people with NAFLD have no symptoms. Occasionally people described a dull ache or discomfort in the right upper abdomen. Usually NAFLD is only diagnosed after having blood tests done routinely.

How is it diagnosed?

There is no diagnostic test that can confirm NAFLD. Clinical features in the history with a liver screen that does not identify any other liver diseases will suggest the diagnosis. The LFTs are often abnormal. A liver biopsy can help confirm the diagnosis however, this does not need to be done in many cases.  An US scan of the liver can be helpful in determining whether there is excessive fat and also more recently there may be a role for MRI scan of the liver as well.

Treatment of NAFLD

  1. Weight loss is recommended if you are overweight or obese. Gradual weight loss programs in conjunction with dieticians and also increased activity and exercise are the best treatment. Some medications are available which may help weight loss.
  2. Optimal treatment of other conditions: for example hypertension (high blood pressure) and good blood sugar control if you have diabetes. Management of these associated conditions can reduce the risk of progression of the liver disease.
  3. Changing or avoiding medications that may be affecting the liver itself may also be of benefit.